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Organization
HEARTLAND FAMILY PHYSICAINS CLINIC
Active
Organization
HEARTLAND FAMILY PHYSICAINS CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RAMIRO ICAZA M.D. (ADMINSTRATOR)
57352433115
Entity
Organization
Contact information
Practice address
2130 E JACKSON BLVD, JACKSON, MO 63755-2907
(573) 243-3115
(573) 243-4700
Mailing address
2130 E JACKSON BLVD, JACKSON, MO 63755-2907
(573) 243-3115
(573) 243-4700
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MDR7D79
MO
Other
Enumeration date
03/06/2007
Last updated
09/22/2010
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