| Heartland Medical Center Llc | |
|
5032 N Illinois St Suite B Fairview Heights IL 62208-3415 | |
| (618) 416-9005 | |
| (618) 641-9452 |
| Full Name | Heartland Medical Center Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 5032 N Illinois St, Fairview Heights, Illinois |
| Authorized Official Name and Position | Benedicta Umoru (PHYSICIAN) |
| Authorized Official Contact | 6184169005 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Heartland Medical Center Llc Po Box 2015 Fairview Heights IL 62208-0215 Ph: (618) 355-9970 | Heartland Medical Center Llc 5032 N Illinois St Suite B Fairview Heights IL 62208-3415 Ph: (618) 416-9005 |
| NPI Number | 1912927351 |
|---|---|
| Provider Enumeration Date | 07/20/2006 |
| Last Update Date | 05/13/2016 |
| Medicare PECOS PAC ID | 1153370861 |
|---|---|
| Medicare Enrollment ID | O20050120000354 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912927351 | NPI | - | NPPES |
| DD7462 | Other | RR MEDICARE | |
| 036100162 | Medicaid | IL | |
| 08232145 | Other | IL | BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 036100162 (Illinois) | Primary |
| Provider Name | Benedicta O Umoru |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1003836446 PECOS PAC ID: 7012901457 Enrollment ID: I20040409000250 |
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