| Medical Resource Center Ltd | |
|
6550 E Riverside Blvd Loves Park IL 61111-4424 | |
| (815) 633-4100 | |
| (815) 633-5141 |
| Full Name | Medical Resource Center Ltd |
|---|---|
| Speciality | General Practice |
| Location | 6550 E Riverside Blvd, Loves Park, Illinois |
| Authorized Official Name and Position | Steven J Disanti (OFFICER) |
| Authorized Official Contact | 8156334100 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Medical Resource Center Ltd 6550 E Riverside Blvd Loves Park IL 61111-4424 Ph: (815) 633-4100 | Medical Resource Center Ltd 6550 E Riverside Blvd Loves Park IL 61111-4424 Ph: (815) 633-4100 |
| NPI Number | 1770507295 |
|---|---|
| Provider Enumeration Date | 07/27/2006 |
| Last Update Date | 02/13/2024 |
| Medicare PECOS PAC ID | 2668635269 |
|---|---|
| Medicare Enrollment ID | O20120517000590 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770507295 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 036096167 (Illinois) | Secondary |
| 208D00000X | General Practice | 036067911 (Illinois) | Primary |
| 208D00000X | General Practice | 036066772 (Illinois) | Secondary |
| Provider Name | Steven J Disanti |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1578582474 PECOS PAC ID: 6305813619 Enrollment ID: I20080218000592 |
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