Heartland Family Physicains Clinic

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MDR7D79 Issued in MO

Legal business name

HEARTLAND FAMILY PHYSICAINS CLINIC

Practice address

2130 E Jackson Blvd
Jackson, MO 63755-2907

Phone

(573) 243-3115

Fax

(573) 243-4700

NPI assigned

Mar 6, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Ramiro Icaza, M.D.

Title

Adminstrator

Phone

57352433115

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1285113600000",
    "number": "1205966645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2130 E JACKSON BLVD",
            "city": "JACKSON",
            "state": "MO",
            "postal_code": "637552907",
            "telephone_number": "573-243-3115",
            "fax_number": "573-243-4700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2130 E JACKSON BLVD",
            "city": "JACKSON",
            "state": "MO",
            "postal_code": "637552907",
            "telephone_number": "573-243-3115",
            "fax_number": "573-243-4700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEARTLAND FAMILY PHYSICAINS CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-06",
        "last_updated": "2010-09-22",
        "status": "A",
        "authorized_official_last_name": "ICAZA",
        "authorized_official_first_name": "RAMIRO",
        "authorized_official_title_or_position": "ADMINSTRATOR",
        "authorized_official_telephone_number": "57352433115",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "MDR7D79",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christina Diane Hart, PHARMD
• Judy L Hart
• Cathlin Hayes
• Nicole R Hazelwood, CRNA
• Heartland Chiropractic Center LLC
• Danielle Nicole Heath, FNP-C
• Suzanne Hightower
• Jaclyn Hiter
• Kimberly Renee Hobbs
• Mark Allen Hobbs

• Family Medicine Physician in Jackson, MO
• Providers in Jackson, MO by specialty
• Family Medicine Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.