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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