Basic Information
| Provider Information | |||||||||
| NPI: | 1790733608 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HEARTLAND REGIONAL MEDICAL CENTER | ||||||||
| LastName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | HEARTLAND SUGICAL ASSOCIATES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 901 HEARTLAND RD | ||||||||
| Address2: | PLAZA II SUITE 1810 | ||||||||
| City: | SAINT JOSEPH | ||||||||
| State: | MO | ||||||||
| PostalCode: | 645066200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8166714888 | ||||||||
| FaxNumber: | 8166714890 | ||||||||
| Practice Location | |||||||||
| Address1: | 901 HEARTLAND RD | ||||||||
| Address2: | PLAZA II SUITE 1810 | ||||||||
| City: | SAINT JOSEPH | ||||||||
| State: | MO | ||||||||
| PostalCode: | 645066200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8166714888 | ||||||||
| FaxNumber: | 8166714890 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | MULDER | ||||||||
| AuthorizedOfficialFirstName: | GEORGE | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 8166714888 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | MOMDR7297 | MO | Y | Hospitals | General Acute Care Hospital |
No ID Information.