MEDICARE: HEARTLAND ALLIANCE HEALTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QF0400X	Federally Qualified Health Center (FQHC)	38369	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2283208	OTHER	IL	BUSINESS LICENSE

General Provider Information

NPI Number	:	1306279070
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEARTLAND ALLIANCE HEALTH

Provider Business Mailing Address
First Line	:	1015 W LAWRENCE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-5017
Country	:	US
Telephone Number	:	773-751-4129
Fax Number	:

Provider Business Practice Location Address
First Line	:	932 W WASHINGTON BLVD FL 2
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60607-2217
Country	:	US
Telephone Number	:	773-275-2586
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	EDWARD STELLON
Credential	:
Telephone Number	:	312-405-0802

Provider Enumeration Date	:	08/16/2013
Last Update Date	:	10/15/2020

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Directions to “HEARTLAND ALLIANCE HEALTH ” Practice Location

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