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General NPI Number Information
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NPI Number | 1306031331
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Entity Type | Organization
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Legal Business Name | HEART CARE USA
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Dates
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Enumeration Date | 09/12/2007
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Last Update Date | 09/12/2007
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Provider Practice Location Address
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Address Line | 10537 S EWING AVE LOWER LEVEL
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City | CHICAGO
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State | IL
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Zip | 60617-6220
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Country | US
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Telephone | 312-212-4570
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Fax | 773-734-0407
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Provider Business Mailing Address
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Address Line | 10537 S EWING AVE LOWER LEVEL
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City | CHICAGO
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State | IL
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Zip | 60617-6220
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Country | US
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Telephone | 312-212-4570
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Fax | 773-734-0407
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Authorized Official
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Title or Position | OWNER
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Name | MR. TERENCE BERNARD ELLIS
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Credential |
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Telephone | 312-212-4570
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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