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840 Blackhawk Blvd South Beloit IL 61080-2263 | |
(815) 490-1600 | |
Not Available |
Full Name | |
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Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
Location | 840 Blackhawk Blvd, South Beloit, Illinois |
Authorized Official Name and Position | Samuel Miller (PRESDIENT & CEO) |
Authorized Official Contact | 8154901737 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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840 Blackhawk Blvd South Beloit IL 61080-2263 Ph: (815) 490-1600 | 840 Blackhawk Blvd South Beloit IL 61080-2263 Ph: (815) 490-1600 |
NPI Number | 1346762390 |
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Provider Enumeration Date | 07/12/2017 |
Last Update Date | 08/24/2022 |
Identifier | Type | State | Issuer |
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1346762390 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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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 | |