Provider Demographics
NPI:1588654784
Name:CASS REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:CASS REGIONAL MEDICAL CENTER
Other - Org Name:GARDEN CITY MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO CASS REGIONAL MEDICAL CENTER
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:PROBASCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-887-5888
Mailing Address - Street 1:2800 E ROCK HAVEN RD
Mailing Address - Street 2:
Mailing Address - City:HARRISONVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64701-4411
Mailing Address - Country:US
Mailing Address - Phone:816-887-0315
Mailing Address - Fax:816-380-0718
Practice Address - Street 1:101 B OLD 7 HWY
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:MO
Practice Address - Zip Code:64747
Practice Address - Country:US
Practice Address - Phone:816-773-6203
Practice Address - Fax:816-773-8885
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CASS REGIONAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-27
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002014283261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO20663016OtherBCBS OF KC
MO598187003Medicaid
MO20663016OtherBCBS OF KC
MO7060000Medicare PIN