Provider Demographics
NPI:1861561524
Name:CITY OF INDEPENDENCE
Entity type:Organization
Organization Name:CITY OF INDEPENDENCE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HEALTH DEPARTMENT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:HEINEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-325-7019
Mailing Address - Street 1:PO BOX 1019
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64051-0519
Mailing Address - Country:US
Mailing Address - Phone:816-325-7185
Mailing Address - Fax:816-325-7098
Practice Address - Street 1:111 E MAPLE AVE
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64050-3066
Practice Address - Country:US
Practice Address - Phone:816-325-7803
Practice Address - Fax:816-325-7024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO12490261251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO9004285Medicare ID - Type Unspecified