Provider Demographics
NPI:1720370232
Name:CASS REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:CASS REGIONAL MEDICAL CENTER
Other - Org Name:KINGSVILLE MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:LANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-380-5888
Mailing Address - Street 1:PO BOX 111
Mailing Address - Street 2:
Mailing Address - City:KINGSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64061-0111
Mailing Address - Country:US
Mailing Address - Phone:816-597-3500
Mailing Address - Fax:816-597-3555
Practice Address - Street 1:305 E PACIFIC ST
Practice Address - Street 2:
Practice Address - City:KINGSVILLE
Practice Address - State:MO
Practice Address - Zip Code:64061-2512
Practice Address - Country:US
Practice Address - Phone:816-597-3500
Practice Address - Fax:816-597-3555
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CASS REGIONAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-05-03
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
7060000Medicare PIN