Provider Demographics
NPI:1023141496
Name:AFFILIATED HEARTLAND PODIATRY
Entity type:Organization
Organization Name:AFFILIATED HEARTLAND PODIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER,PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:BURNETT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:913-557-0700
Mailing Address - Street 1:2102 BAPTISTE DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:PAOLA
Mailing Address - State:KS
Mailing Address - Zip Code:66071-1314
Mailing Address - Country:US
Mailing Address - Phone:913-557-0700
Mailing Address - Fax:866-254-5538
Practice Address - Street 1:2102 BAPTISTE DR
Practice Address - Street 2:SUITE D
Practice Address - City:PAOLA
Practice Address - State:KS
Practice Address - Zip Code:66071-1314
Practice Address - Country:US
Practice Address - Phone:913-557-0700
Practice Address - Fax:866-254-5538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS12-00312213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DG2679OtherRR MCR
4857030001OtherDMERC
MOP130000AMedicare PIN
KSP130000Medicare PIN
KS4857030001Medicare NSC
KS114105Medicare PIN