Provider Demographics
NPI:1760472922
Name:CASS REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:CASS REGIONAL MEDICAL CENTER
Other - Org Name:ARCHIE MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-887-0315
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 1:709 E PINE ST.
Practice Address - Street 2:
Practice Address - City:ARCHIE
Practice Address - State:MO
Practice Address - Zip Code:64725
Practice Address - Country:US
Practice Address - Phone:816-430-5777
Practice Address - Fax:816-430-5219
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 Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO593863004Medicaid
MO24824010OtherBCBS OF KC
MO24824010OtherBCBS OF KC
MO268522Medicare Oscar/Certification