STUART HICKERSON (NPI# 1073629374) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073629374 |
| Entity Type | Individual |
| Full Name | STUART HICKERSON |
| Practice Address |
12528 Sr 78 Havana IL 62644-6866 |
| Mailing Address |
3333 N Seminary St Galesburg IL 61401-1251 |
| Practice Telephone | 3095434253 |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2013-04-24 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207PE0004X |
Emergency Medicine Specialization: Emergency Medical Services |
036083126 | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | 036083126 | 05 |
| Street Address |
12528 SR 78 |
| City | HAVANA |
| State | IL |
| Zip Code | 62644-6866 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750833356 | Melissa Glass | Clinical Nurse Specialist | 12528 Sr 78, Havana, IL 62644-6866 | 2016-10-29 |
| 1174902696 | Ashley Marmon | Nurse Practitioner | 12528 Sr 78, Havana, IL 62644-6866 | 2015-05-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982771218 | Mason County Health Department | Clinic/Center | 1002 East Laurel Avenue, Havana, IL 62644 | 2006-11-30 |
| 1346206315 | Havana Hco, LLC | Skilled Nursing Facility | 609 N Harpham St, Havana, IL 62644 | 2006-04-26 |
| 1902849649 | Mason Hospital District | General Acute Care Hospital | 615 N Promenade St, Havana, IL 62644-1015 | 2006-06-13 |
| 1356307433 | Bruce Schultz | Family Medicine | 615 N Promenade St, Havana, IL 62644-1015 | 2006-04-26 |
| 1245296979 | Tad A Yetter | Internal Medicine | 615 N Promenade St, Havana, IL 62644-1015 | 2006-04-21 |
| 1427561489 | Brandi Nicole Behymer | Nurse's Aide | 320 N Plum St, Havana, IL 62644-1127 | 2017-11-13 |
| 1225032071 | R & Q Corporation | Pharmacy | 201 W Main St, Havana, IL 62644-1137 | 2005-06-09 |
| 1639655616 | Home Dialysis Therapies, Inc | Clinic/Center | 216 W Main St, Havana, IL 62644-1138 | 2018-07-12 |
| 1750382990 | Anthony Dale Roberts | Chiropractor | 303 W Main St, Havana, IL 62644-1139 | 2005-08-10 |
| 1962816868 | John Stinauer | Dentist | 312 W Main St, Havana, IL 62644-1140 | 2014-06-18 |
| Find all providers in zip 62644 | ||||
| Taxonomy Code | 207PE0004X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Emergency Medicine |
| Specialization | Emergency Medical Services |
| An emergency medicine physician who specializes in non-hospital based emergency medical services (e.g., disaster site, accident scene, transport vehicle, etc.) to provide pre-hospital assessment, treatment, and transport patients. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A Certification of Added Qualifications (CAQ) is issued by the American Osteopathic Board of Emergency Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033760715 | Michael James Doolin | Emergency Medicine | 1338 S Clinton St, Chicago, IL 60607-5037 | 2019-09-24 |
| 1578091971 | The Board of Trustee for The University of Illinois | Emergency Medicine | 10000 West O'hare, Terminal 2, Chicago, IL 60660-0508 | 2017-05-30 |
| 1669712808 | Kathryn Theresa Pajak | Emergency Medicine | 5659 S Oak Park Ave, Chicago, IL 60638-3227 | 2013-02-26 |
| 1174832976 | Craig William Dean | Emergency Medicine | 155 N Harbor Dr Apt 309, Chicago, IL 60601-7386 | 2010-09-28 |
| 1770809881 | King, Ltd | Emergency Medicine | 9332 S Vanderpoel Ave, Chicago, IL 60643-5852 | 2010-04-14 |
| 1306098231 | Robert Dietz Tetik | Emergency Medicine | 2272 95th St Ste 106, Naperville, IL 60564-8942 | 2008-10-22 |
| 1831384643 | Primus Trauma Care LLC | Emergency Medicine | 1304 Franklin Avenue, Normal, IL 61761 | 2007-09-14 |
| 1245355411 | Pekin Memorial Hospital | Emergency Medicine | 600 So 13th Street, Pekin, IL 61554-4969 | 2007-03-20 |
| 1396879268 | Nanci A Cherry | Emergency Medicine | 7419 Bell Harbour Dr, Rockford, IL 61114-6600 | 2007-03-15 |
| 1972609782 | Jennifer Lynn Webb | Emergency Medicine | 15730 Robert Louis Dr, Plainfield, IL 60544-2146 | 2006-09-16 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.