Provider Demographics
NPI:1952314833
Name:HEIDER, ALLISON A (MD)
Entity Type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:A
Last Name:HEIDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 802843
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64180-2843
Mailing Address - Country:US
Mailing Address - Phone:417-730-6430
Mailing Address - Fax:417-269-7567
Practice Address - Street 1:1000 E HIGHWAY 60
Practice Address - Street 2:
Practice Address - City:MONETT
Practice Address - State:MO
Practice Address - Zip Code:65708-8258
Practice Address - Country:US
Practice Address - Phone:417-236-2600
Practice Address - Fax:417-236-2619
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002014059207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO209330307Medicaid
KS200717080AMedicaid
194289OtherBLUE CROSS MO
MO209330307Medicaid
KS068002112OtherMEDICARE PTAN
H63715Medicare UPIN
925310038Medicare PIN
925313391Medicare PIN