| Heartland Health Service - Broadway | |
|
19 Olt Ave Pekin IL 61554-6214 | |
| (309) 680-7600 | |
| (309) 353-3334 |
| Full Name | Heartland Health Service - Broadway |
|---|---|
| Speciality | Clinic/Center |
| Location | 19 Olt Ave, Pekin, Illinois |
| Authorized Official Name and Position | Sharon A Adams (CEO) |
| Authorized Official Contact | 3096807665 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Heartland Health Service - Broadway 2214 N University St Peoria IL 61604-3221 Ph: (309) 680-7600 | Heartland Health Service - Broadway 19 Olt Ave Pekin IL 61554-6214 Ph: (309) 680-7600 |
| NPI Number | 1104276492 |
|---|---|
| Provider Enumeration Date | 06/16/2016 |
| Last Update Date | 03/12/2022 |
| Medicare PECOS PAC ID | 7416850318 |
|---|---|
| Medicare Enrollment ID | O20170718003582 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104276492 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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