Provider Demographics
NPI:1962647115
Name:CASS REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:CASS REGIONAL MEDICAL CENTER
Other - Org Name:DBA ARCHIE MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:LANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-380-5888
Mailing Address - Street 1:709 E PINE ST
Mailing Address - Street 2:
Mailing Address - City:ARCHIE
Mailing Address - State:MO
Mailing Address - Zip Code:64725-9215
Mailing Address - Country:US
Mailing Address - Phone:816-430-5777
Mailing Address - Fax:816-430-5219
Practice Address - Street 1:709 E PINE ST
Practice Address - Street 2:
Practice Address - City:ARCHIE
Practice Address - State:MO
Practice Address - Zip Code:64725-9215
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:2008-12-02
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO20663016OtherBCBS OF KC
MO7060000Medicare PIN