Organization
HEART CITY HEALTH CENTER, INC.
Active
Parent organization
HEART CITY HEALTH CENTER, INC.
Organization subpart
Yes
Provider details
NPI number
Legal business name
HEART CITY HEALTH CENTER, INC.
Authorized official
ESLEEN E FULTZ (CEO)
(574) 970-3257
Entity
Organization
Contact information
Practice address
1545 CASSOPOLIS STREET, ELKHART, IN 46514
(574) 293-0052
(574) 293-3744
Mailing address
236 SIMPSON AVENUE, ELKHART, IN 46516-4666
(574) 293-0052
(574) 293-1739
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
IN
Enumeration date
10/14/2019
Last updated
10/14/2019
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