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1215 N Alpine Rd Rockford IL 61107-2201 | |
(815) 490-1600 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 1215 N Alpine Rd, Rockford, Illinois |
Authorized Official Name and Position | Samuel Miller (PRESIDENT & CEO) |
Authorized Official Contact | 8154901737 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1215 N Alpine Rd Rockford IL 61107-2201 Ph: (815) 490-1600 | 1215 N Alpine Rd Rockford IL 61107-2201 Ph: (815) 490-1600 |
NPI Number | 1508306861 |
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Provider Enumeration Date | 03/06/2017 |
Last Update Date | 08/24/2022 |
Medicare PECOS PAC ID | 5799682993 |
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Medicare Enrollment ID | O20170620000014 |
Identifier | Type | State | Issuer |
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1508306861 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Gautam Gupta Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 6090 Strathmoor Dr, Suite #4, Rockford, IL 61107 Phone: 815-229-1899 Fax: 815-231-1218 | |
Rockford School District Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 401 N Gardiner Ave, Rockford, IL 61107 Phone: 815-398-3976 | |
Rockford Adult Medicine Associates S C Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 534 Roxbury Rd, Rockford, IL 61107 Phone: 815-381-7005 | |