Basic Information
| Provider Information | |||||||||
| NPI: | 1801242474 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HOSPITAL CARE CONSULTANTS OF GALESBURG, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17304 PRESTON RD STE 1400 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752525633 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8669318882 | ||||||||
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| Practice Location | |||||||||
| Address1: | 695 N KELLOGG ST | ||||||||
| Address2: | |||||||||
| City: | GALESBURG | ||||||||
| State: | IL | ||||||||
| PostalCode: | 614012807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3093438131 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2016 | ||||||||
| LastUpdateDate: | 06/15/2016 | ||||||||
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| AuthorizedOfficialLastName: | WEISS | ||||||||
| AuthorizedOfficialFirstName: | RON | ||||||||
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| AuthorizedOfficialTitleorPosition: | SOLE MBR | ||||||||
| AuthorizedOfficialTelephone: | 8669318882 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Hospitalist | 207P00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.