Provider Demographics
NPI:1710925797
Name:HEART OF THE VALLEY HEALTHCARE PC
Entity Type:Organization
Organization Name:HEART OF THE VALLEY HEALTHCARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:EILEEN J
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:563-426-5136
Mailing Address - Street 1:1014 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IA
Mailing Address - Zip Code:52141-9616
Mailing Address - Country:US
Mailing Address - Phone:563-426-5136
Mailing Address - Fax:563-426-5139
Practice Address - Street 1:1014 MAIN ST
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IA
Practice Address - Zip Code:52141-9616
Practice Address - Country:US
Practice Address - Phone:563-426-5136
Practice Address - Fax:563-426-5139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA-112377363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI11817OtherINDV. MEDICARE LEGACY
IA0499350Medicaid
IA0499350Medicaid