| Suzan Olivia Lisenby, MD | |
| 5301 Faraon St Ste 200, Saint Joseph, MO 64506-3829 | |
| (816) 271-7673 | |
| (816) 271-4924 | 
| Full Name | Suzan Olivia Lisenby | 
|---|---|
| Gender | Female | 
| Speciality | Physical Medicine & Rehabilitation | 
| Location | 5301 Faraon St Ste 200, Saint Joseph, Missouri | 
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1629572771 | NPI | - | NPPES | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 208100000X | Physical Medicine & Rehabilitation | 11405437-1205 (Utah) | Secondary | 
| 208100000X | Physical Medicine & Rehabilitation | 2022033965 (Missouri) | Primary | 
| Entity Name | Heartland Regional Medical Center | 
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice | 
| Entity Identifiers | NPI Number: 1477575405 PECOS PAC ID: 6709772767 Enrollment ID: O20040225001201 | 
| Mailing Address | Practice Location Address | 
|---|---|
| Suzan Olivia Lisenby, MD 5301 Faraon St Ste 200, Saint Joseph, MO 64506-3829 Ph: (816) 271-7673 | Suzan Olivia Lisenby, MD 5301 Faraon St Ste 200, Saint Joseph, MO 64506-3829 Ph: (816) 271-7673 | 
| Dr. Kenton C. Freeman, MD Physical Medicine & Rehabilitation Medicare: Not Enrolled in Medicare Practice Location: 218 S Woodbine Rd, Saint Joseph, MO 64506 Phone: 816-383-3680 | |
| Anne A. Idiculla, M.D. Physical Medicine & Rehabilitation Medicare: Not Enrolled in Medicare Practice Location: 802 N Riverside Rd, Suite 260, Saint Joseph, MO 64507 Phone: 816-271-7673 Fax: 816-271-4924 | |
| Mrs. Jessica Nicole Bledsoe, PTA Physical Medicine & Rehabilitation Medicare: Not Enrolled in Medicare Practice Location: 3302 N Woodbine Rd, Saint Joseph, MO 64505 Phone: 816-820-8968 | |
| William A. Dodson, M.D. Physical Medicine & Rehabilitation Medicare: Accepting Medicare Assignments Practice Location: 802 N Riverside Rd, Suite 150, Saint Joseph, MO 64507 Phone: 816-271-4025 Fax: 816-271-4026 | |
| Sydni Marie Kaden, MS, LAT, ATC Physical Medicine & Rehabilitation Medicare: Not Enrolled in Medicare Practice Location: 802 N Riverside Rd Ste 130, Saint Joseph, MO 64507 Phone: 816-271-6664 Fax: 816-271-4924 | |
| Dr. Anthony Ezemba,  Physical Medicine & Rehabilitation Medicare: Accepting Medicare Assignments Practice Location: 5301 Faraon St Ste 200, Saint Joseph, MO 64506 Phone: 816-271-7673 Fax: 816-271-4924 | |
| Dr. Peter Anthony Dawson, MD Physical Medicine & Rehabilitation Medicare: Accepting Medicare Assignments Practice Location: 802 N Riverside Rd Ste 130, Saint Joseph, MO 64507 Phone: 816-271-7673 Fax: 816-271-4924 |