Organization
HEARTLAND REGIONAL MEDICAL CENTER
Active
Other names
Lakeside Pediatrics
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN WILSON (CHIEF FINANCIAL OFFICER)
(816) 271-6611
Entity
Organization
Contact information
Practice address
902 N RIVERSIDE RD, SUITE 100, SAINT JOSEPH, MO 64507-2559
(816) 271-1351
(816) 271-1355
Mailing address
5325 FARAON ST, SAINT JOSEPH, MO 64506-3488
(816) 271-1351
(816) 271-1355
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MD116083
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
540156809
—
MO
Enumeration date
12/11/2006
Last updated
06/30/2015
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