Healthcare Provider Details

I. General information

NPI: 1659147049
Provider Name (Legal Business Name): VITAS HEALTHCARE CORPORATION MIDWEST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2023
Last Update Date: 11/28/2023
Certification Date: 11/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 EXECUTIVE DR STE 100
FAIRVIEW HEIGHTS IL
62208-1366
US

IV. Provider business mailing address

255 E 5TH ST STE 1050
CINCINNATI OH
45202-4121
US

V. Phone/Fax

Practice location:
  • Phone: 618-622-9073
  • Fax:
Mailing address:
  • Phone: 513-618-2243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: NICHOLAS WESTFALL
Title or Position: PRESIDENT & CEO
Credential:
Phone: 513-618-2240