Provider Demographics
NPI:1407183734
Name:HEARTLAND INTERNATIONAL HEALTH CENTER
Entity Type:Organization
Organization Name:HEARTLAND INTERNATIONAL HEALTH CENTER
Other - Org Name:HEARTLAND HEALTH CENTER-CLARK
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BECHARA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOUCAIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-751-1700
Mailing Address - Street 1:4750 N SHERIDAN RD
Mailing Address - Street 2:#434
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-7528
Mailing Address - Country:US
Mailing Address - Phone:773-751-1700
Mailing Address - Fax:773-275-3689
Practice Address - Street 1:4740 N CLARK ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-4689
Practice Address - Country:US
Practice Address - Phone:773-751-1700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-06
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)