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General NPI Number Information
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NPI Number | 1659712495
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Entity Type | Organization
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Legal Business Name | HEIT HEALTH CENTER SC
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Dates
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Enumeration Date | 07/09/2013
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Last Update Date | 07/09/2013
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Provider Practice Location Address
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Address Line | 7445 E STATE ST
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City | ROCKFORD
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State | IL
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Zip | 61108-2678
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Country | US
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Telephone | 815-399-8560
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Fax | 815-399-6107
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Provider Business Mailing Address
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Address Line | 7445 E STATE ST
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City | ROCKFORD
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State | IL
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Zip | 61108-2678
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Country | US
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Telephone | 815-399-8560
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Fax | 815-399-6107
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Authorized Official
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Title or Position | MANAGER
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Name | KARLA GALLIVAN
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Credential |
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Telephone | 815-399-5860
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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