Healthcare Provider Details

I. General information

NPI: 1922665702
Provider Name (Legal Business Name): HEARTLAND WOMEN'S HEALTHCARE LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2019
Last Update Date: 05/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 HEALTH CARE DR
GREENVILLE IL
62246-1161
US

IV. Provider business mailing address

3230 VETERANS MEMORIAL DR
MOUNT VERNON IL
62864-5950
US

V. Phone/Fax

Practice location:
  • Phone: 618-997-5266
  • Fax: 618-997-5285
Mailing address:
  • Phone: 618-997-5266
  • Fax: 618-997-5285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALEJANDRA ALLI
Title or Position: SR. MANAGER PROGRAM DELIVERY
Credential:
Phone: 618-997-5266