Provider Demographics
NPI:1073831210
Name:HEART CHECK AMERICA TINLEY PARK LLC
Entity Type:Organization
Organization Name:HEART CHECK AMERICA TINLEY PARK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SHORT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-489-6305
Mailing Address - Street 1:9501 171ST ST STE Q
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60487-6111
Mailing Address - Country:US
Mailing Address - Phone:708-364-0867
Mailing Address - Fax:708-364-0874
Practice Address - Street 1:9501 171ST ST STE Q
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60487-6111
Practice Address - Country:US
Practice Address - Phone:708-364-0867
Practice Address - Fax:708-364-0874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-12
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL03611047261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center