Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of October 4, 2026.

Heartland Family Physicains Clinic

Organization Family Medicine Physician · NPI 1205966645

Heartland Family Physicains Clinic provides Family Medicine Physician services 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 Not confirmed with CMS for 16 years — call before visiting
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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