Provider Demographics
NPI:1093413411
Name:RHWHEALTHCAREPLLC
Entity Type:Organization
Organization Name:RHWHEALTHCAREPLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-335-2037
Mailing Address - Street 1:115 BIRCH CT
Mailing Address - Street 2:
Mailing Address - City:DAHINDA
Mailing Address - State:IL
Mailing Address - Zip Code:61428-9767
Mailing Address - Country:US
Mailing Address - Phone:309-335-2037
Mailing Address - Fax:
Practice Address - Street 1:115 BIRCH CT
Practice Address - Street 2:
Practice Address - City:DAHINDA
Practice Address - State:IL
Practice Address - Zip Code:61428-9767
Practice Address - Country:US
Practice Address - Phone:309-335-2037
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-16
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care