Provider Demographics
NPI:1962679936
Name:CASS REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:CASS REGIONAL MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
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 1:1800 E MECHANIC
Mailing Address - Street 2:
Mailing Address - City:HARRISONVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64701-2017
Mailing Address - Country:US
Mailing Address - Phone:816-380-3474
Mailing Address - Fax:816-380-4639
Practice Address - Street 1:1800 E MECHANIC
Practice Address - Street 2:
Practice Address - City:HARRISONVILLE
Practice Address - State:MO
Practice Address - Zip Code:64701-2017
Practice Address - Country:US
Practice Address - Phone:816-380-3474
Practice Address - Fax:816-380-4639
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CASS REGIONAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-09
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO219422085R0202X, 261QR0200X, 261QR0206X, 261QR0207X, 261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography
No261QR0207XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile Mammography
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO010494003Medicaid
MO261324Medicare Oscar/Certification
MO010494003Medicaid
MOP360000Medicare UPIN