NPIMap

Organization Active NPI

Heartland International Health Center

Doing business as Heartland Health Center - Clark

  • Dentist
  • Chicago, IL
National Provider Identifier
1215258116
Registry record updated Jun 15, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
019027796 Issued in IL
Legal business name
HEARTLAND INTERNATIONAL HEALTH CENTER
Doing business as
Heartland Health Center - Clark
Practice address
4740 N Clark St
Chicago, IL 60640-4689
Phone
(773) 751-1700
NPI assigned
Jun 15, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Gwenn Rausch
Title
Executive Director
Phone
(773) 296-7589

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 019027796 IL Primary

Addresses

Primary practice location

4740 N Clark St
Chicago, IL 60640-4689

Mailing address

3048 N Wilton Ave
2ND Floor
Chicago, IL 60657-6710
Phone (773) 296-7544

Other names 1

  • Heartland Health Center - Clark Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Heartland Health Centers24 organizations share this tax ID, including this one

Other organizations with this tax ID 23

Organizations that report the same tax identification number in the National Provider Directory.

View all 23

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1276560000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1276560000000",
    "number": "1215258116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3048 N WILTON AVE",
            "address_2": "2ND FLOOR",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606576710",
            "telephone_number": "773-296-7544"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4740 N CLARK ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606404689",
            "telephone_number": "773-751-1700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEARTLAND INTERNATIONAL HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-15",
        "last_updated": "2010-06-15",
        "status": "A",
        "authorized_official_last_name": "RAUSCH",
        "authorized_official_first_name": "GWENN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "773-296-7589"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "IL",
            "license": "019027796",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Heartland Health Center - Clark",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.