NPIMap

Organization Active NPI

Heartland International Health Center

Doing business as Heartland Health Center-Wilson

  • General Practice Dentistry
  • Chicago, IL
National Provider Identifier
1790942084
Registry record updated Sep 20, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
003 Issued in IL
Legal business name
HEARTLAND INTERNATIONAL HEALTH CENTER
Doing business as
Heartland Health Center-Wilson
Practice address
845 W Wilson Ave
Chicago, IL 60640-5704
Phone
(773) 728-7264
Fax
(773) 728-7557
NPI assigned
May 22, 2008
Last updated
Sep 20, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 20, 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
General Practice Dentistry 1223G0001X 003 IL Primary

Addresses

Primary practice location

845 W Wilson Ave
Chicago, IL 60640-5704

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
103527OtherILDORAL DENTAL

Other names 1

  • Heartland Health Center-Wilson 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

Locations

845 W Wilson Ave
Chicago, IL 60640
Phone (312) 744-1295

NPI Registry JSON

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

{
    "created_epoch": "1211414400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1284940800000",
    "number": "1790942084",
    "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",
            "fax_number": "773-751-4175"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "845 W WILSON AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606405704",
            "telephone_number": "773-728-7264",
            "fax_number": "773-728-7557"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEARTLAND INTERNATIONAL HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-22",
        "last_updated": "2010-09-20",
        "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": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "003",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DORAL DENTAL",
            "identifier": "103527",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Heartland Health Center-Wilson",
            "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 Sep 20, 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.