Provider Demographics
NPI:1457375859
Name:HEARTLAND REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:HEARTLAND REGIONAL MEDICAL CENTER
Other - Org Name:COUNSELING CARE MOSAIC LIFE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, REIMBURSEMENT - ACCOUNTIN
Authorized Official - Prefix:
Authorized Official - First Name:DWIGHT
Authorized Official - Middle Name:
Authorized Official - Last Name:CARVELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-273-0473
Mailing Address - Street 1:137 N BELT HWY
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-3491
Mailing Address - Country:US
Mailing Address - Phone:816-271-6573
Mailing Address - Fax:816-271-6572
Practice Address - Street 1:3620 FREDERICK AVE
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-3016
Practice Address - Country:US
Practice Address - Phone:816-271-6573
Practice Address - Fax:816-271-6572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO00996103T00000X
MO00711103T00000X
103T00000X
MOSW001949104100000X
MOSW000121104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO18524038OtherBLUE CROSS/ BLUE SHIELD
MO10001309000OtherCOMMUNITY HEALTH PLAN
MO215265836OtherUBH
MO241020OtherVALUE OPTIONS