Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Heartland Family Physicains Clinic

Organization Family Medicine Physician · NPI 1205966645

Heartland Family Physicains Clinic is a Family Medicine Physician in Jackson, Missouri. Licensed in Missouri. Registered with an NPI since 2007.

Licensed in
MO
In the registry since
2007

Practice location Address checks out

2130 E Jackson Blvd
Jackson, MO 63755-2907
Phone: (573) 243-3115
Fax: (573) 243-4700
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence MDR7D79 (MO)

Record details

NPI number1205966645
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Ramiro Icaza — Adminstrator · 57352433115
NPI enumeratedMarch 6, 2007
Last updated in NPPESSeptember 22, 2010
Mailing address2130 E Jackson Blvd, Jackson, MO 63755-2907

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