Provider Demographics
NPI:1942038427
Name:HEARTFELT MEDICAL GROUP LLC
Entity type:Organization
Organization Name:HEARTFELT MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:MBULA
Authorized Official - Last Name:MUTUNGA
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:913-660-5365
Mailing Address - Street 1:9743 SHADY BEND CIR
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66227-7326
Mailing Address - Country:US
Mailing Address - Phone:913-424-2446
Mailing Address - Fax:
Practice Address - Street 1:10810 W 75TH ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66214-1184
Practice Address - Country:US
Practice Address - Phone:913-660-5365
Practice Address - Fax:913-660-5365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty