| |
245 Prairie Hill Rd South Beloit IL 61080-2579 | |
(815) 490-1600 | |
Not Available |
Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 245 Prairie Hill Rd, South Beloit, 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 |
---|---|
245 Prairie Hill Rd South Beloit IL 61080-2579 Ph: (815) 490-1600 | 245 Prairie Hill Rd South Beloit IL 61080-2579 Ph: (815) 490-1600 |
NPI Number | 1811419245 |
---|---|
Provider Enumeration Date | 07/07/2017 |
Last Update Date | 08/24/2022 |
Medicare PECOS PAC ID | 5799682993 |
---|---|
Medicare Enrollment ID | O20170830001110 |
Identifier | Type | State | Issuer |
---|---|---|---|
1811419245 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
South Beloit Office Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1407 Pate Plaza Dr, South Beloit, IL 61080 Phone: 630-219-2002 | |