Provider Demographics
NPI:1558839035
Name:HEART OF ILLINOIS HEARING LLC
Entity Type:Organization
Organization Name:HEART OF ILLINOIS HEARING LLC
Other - Org Name:HEART OF ILLINOIS HEARING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HCP/VP
Authorized Official - Prefix:
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:HEFLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-681-8500
Mailing Address - Street 1:137 FAWN HAVEN DR
Mailing Address - Street 2:
Mailing Address - City:EAST PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61611-1879
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5401 N KNOXVILLE AVE STE 116
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-5011
Practice Address - Country:US
Practice Address - Phone:309-681-8500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-02
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty