| Heart City Health Center, Inc. | |
|
2100 Superior St Elkhart IN 46516-4704 | |
| (574) 970-1937 | |
| (574) 970-1939 |
| Full Name | Heart City Health Center, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 2100 Superior St, Elkhart, Indiana |
| Authorized Official Name and Position | Esleen E Fultz (CEO) |
| Authorized Official Contact | 5749703257 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Heart City Health Center, Inc. 236 Simpson Ave Elkhart IN 46516-4666 Ph: (574) 584-7373 | Heart City Health Center, Inc. 2100 Superior St Elkhart IN 46516-4704 Ph: (574) 970-1937 |
| NPI Number | 1811551211 |
|---|---|
| Provider Enumeration Date | 05/01/2019 |
| Last Update Date | 05/01/2019 |
| Medicare PECOS PAC ID | 9931008380 |
|---|---|
| Medicare Enrollment ID | O20190726002004 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811551211 | NPI | - | NPPES |
| PENDING | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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