Healthcare Provider Details

I. General information

NPI: 1801280409
Provider Name (Legal Business Name): HEARTLAND WOMEN'S HEALTHCARE, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2015
Last Update Date: 07/11/2024
Certification Date: 07/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3130 VETERANS MEMORIAL DR
MOUNT VERNON IL
62864-5951
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 TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL J SCHIFANO
Title or Position: PRESIDENT
Credential: D.O.
Phone: 618-997-5266