Provider Demographics
NPI:1033699467
Name:HEALTHPOINTE MEDICAL CENTER SC
Entity Type:Organization
Organization Name:HEALTHPOINTE MEDICAL CENTER SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DESIGNATED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:M
Authorized Official - Last Name:GALLON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:314-495-6037
Mailing Address - Street 1:530 FULLERTON RD STE B
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:IL
Mailing Address - Zip Code:62226-2970
Mailing Address - Country:US
Mailing Address - Phone:618-233-3324
Mailing Address - Fax:618-233-4758
Practice Address - Street 1:530 FULLERTON RD STE B
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-2970
Practice Address - Country:US
Practice Address - Phone:618-233-3324
Practice Address - Fax:618-233-4758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-15
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Multi-Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1033699467OtherTYPE 2 NPI