Provider Demographics
NPI:1659712495
Name:HEIT HEALTH CENTER SC
Entity Type:Organization
Organization Name:HEIT HEALTH CENTER SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-399-5860
Mailing Address - Street 1:7445 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-2678
Mailing Address - Country:US
Mailing Address - Phone:815-399-8560
Mailing Address - Fax:815-399-6107
Practice Address - Street 1:7445 E STATE ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2678
Practice Address - Country:US
Practice Address - Phone:815-399-8560
Practice Address - Fax:815-399-6107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-09
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty