NPIMap

Organization Active NPI

Heartland Health Outreach

  • General Practice Dentistry
  • Chicago, IL
National Provider Identifier
1447417118
Registry record updated May 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
017 Issued in IL
Legal business name
HEARTLAND HEALTH OUTREACH
Practice address
2418 W Division St
Chicago, IL 60622-2940
Phone
(773) 252-6413
Fax
(773) 252-6417
NPI assigned
May 20, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 20, 2008

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

Authorized official

Name
Heidi Nelson
Title
Controller
Phone
(773) 751-4107

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 017 IL Primary

Addresses

Primary practice location

2418 W Division St
Chicago, IL 60622-2940

Mailing address

4750 N Sheridan Rd
Suite 434
Chicago, IL 60640-7528
Phone (773) 751-1704

Other identifiers 2

IdentifierTypeStateIssuer
103326OtherILDORAL DENTAL
017MedicaidIL

Other names 1

  • Spang Dental Center West Other name

National Provider Directory

National Provider Directory
Tax ID family
Heartland Alliance Health14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1211241600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211241600000",
    "number": "1447417118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4750 N SHERIDAN RD",
            "address_2": "SUITE 434",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606407528",
            "telephone_number": "773-751-1704",
            "fax_number": "773-751-4175"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2418 W DIVISION ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606222940",
            "telephone_number": "773-252-6413",
            "fax_number": "773-252-6417"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEARTLAND HEALTH OUTREACH",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-20",
        "last_updated": "2008-05-20",
        "status": "A",
        "authorized_official_last_name": "NELSON",
        "authorized_official_first_name": "HEIDI",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "773-751-4107"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "017",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DORAL DENTAL",
            "identifier": "103326",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "017",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Spang Dental Center West",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 May 20, 2008; 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.