Provider Demographics
NPI:1679531263
Name:HEARTLAND CLINIC
Entity Type:Organization
Organization Name:HEARTLAND CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:H
Authorized Official - Last Name:ANDRES
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:816-671-4888
Mailing Address - Street 1:901 HEARTLAND RD
Mailing Address - Street 2:PLAZA II SUITE 1810
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-6200
Mailing Address - Country:US
Mailing Address - Phone:816-671-4888
Mailing Address - Fax:816-671-4890
Practice Address - Street 1:901 HEARTLAND RD
Practice Address - Street 2:PLAZA II SUITE 1810
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-6200
Practice Address - Country:US
Practice Address - Phone:816-671-4888
Practice Address - Fax:816-671-4890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMOR4278261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOC52300Medicare UPIN