Organization
HEARTLAND PHYSICIAN SERVICES, LLC
Active
Parent organization
HEALIENT PHYSICIAN GROUP
Other names
Kansas City Family Medical Care
Organization subpart
Yes
Provider details
NPI number
Legal business name
HEALIENT PHYSICIAN GROUP
Authorized official
PAM GAVIN (PRACTICE MANAGER)
(816) 941-9030
Entity
Organization
Contact information
Practice address
1004 CARONDELET DR, STE 300A, KANSAS CITY, MO 64114-4801
(816) 941-9030
(816) 941-3866
Mailing address
1004 CARONDELET DR, STE 300A, KANSAS CITY, MO 64114-4801
(816) 941-9030
(816) 941-3866
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
101923
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MA4728
MEDICARE PTAN
MO
Enumeration date
08/16/2006
Last updated
06/05/2014
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