Stuart Hickerson
Emergency Medical Services
12528 Sr 78
Havana
, Illinois 62644-6866
Stuart Hickerson
Emergency Medical Services
12528 Sr 78
Havana
, Illinois 62644-6866
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About
Features
Specialties
- Emergency Medical Services
Languages spoken
- English
Location
First Address
- Stuart Hickerson
- 3333 N Seminary St
- Galesburg, IL
- Zip : 61401-1251
- Phone :
Second Address
- Stuart Hickerson
- 12528 Sr 78
- Havana, IL
- Zip : 62644-6866
- Phone : (309) 543-4253
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FAQs
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207PE0004X | Emergency Medical Services | 036083126 | IL |
National Provider Identifier
| NPI | 1073629374 |
|---|---|
| Provider Name | Stuart Hickerson |
| First Address | Galesburg, IL 61401-1251 |
| Second Address | Havana, IL 62644-6866 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 21/08/2006 |
| Last Update Date | 24/04/2013 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 036083126 | (05) | IL |
| G15252 | (02) | IL |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.