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General NPI Number Information
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NPI Number | 1215355110
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Entity Type | Organization
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Legal Business Name | HEALOGICS SPECIALTY PHYSICIANS OF ILLINOIS, LLC
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Dates
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Enumeration Date | 03/29/2014
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Last Update Date | 06/01/2023
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Provider Practice Location Address
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Address Line | 1 MEMORIAL DR
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City | ALTON
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State | IL
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Zip | 62002-6722
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Country | US
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Telephone | 616-433-7066
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Fax | 314-653-4088
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Provider Business Mailing Address
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Address Line | 5220 BELFORT RD STE 130
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City | JACKSONVILLE
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State | FL
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Zip | 32256-6018
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Country | US
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Telephone | 904-446-3451
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Fax | 904-446-3032
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Authorized Official
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Title or Position | CEO
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Name | FRANK WILLIAM
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Credential |
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Telephone | 904-446-3519
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 2083P0011X
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Taxonomy Name | Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
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License Number |
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License Number State |
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