| |
2560 24th St Suite 202 Rock Island IL 61201-5357 | |
(309) 786-3395 | |
(309) 779-3084 |
Full Name | |
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Speciality | Family Medicine |
Location | 2560 24th St, Rock Island, Illinois |
Authorized Official Name and Position | Mark G Rogers (VICE PRESIDENT OF FINANCE) |
Authorized Official Contact | 5634216513 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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865 Lincoln Rd Ste L120 Bettendorf IA 52722-4190 Ph: (563) 355-9191 | 2560 24th St Suite 202 Rock Island IL 61201-5357 Ph: (309) 786-3395 |
NPI Number | 1811003189 |
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Provider Enumeration Date | 08/21/2006 |
Last Update Date | 09/29/2009 |
Identifier | Type | State | Issuer |
---|---|---|---|
1811003189 | NPI | - | NPPES |
5727210004 | Other | DMERC |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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