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5605 East Rockton Rd North Pointe Roscoe IL 61073-7601 | |
(815) 525-4500 | |
(608) 364-2338 |
Full Name | |
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Speciality | Internal Medicine |
Location | 5605 East Rockton Rd, Roscoe, Illinois |
Authorized Official Name and Position | William P Sullivan (ADMINISTRATOR) |
Authorized Official Contact | 6083642200 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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1905 Huebbe Parkway Beloit Clinic Sc Beloit WI 53511-1842 Ph: (608) 364-2200 | 5605 East Rockton Rd North Pointe Roscoe IL 61073-7601 Ph: (815) 525-4500 |
NPI Number | 1497879878 |
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Provider Enumeration Date | 03/19/2007 |
Last Update Date | 02/06/2008 |
Identifier | Type | State | Issuer |
---|---|---|---|
1497879878 | NPI | - | NPPES |
32808500 | Medicaid | WI | |
32270100 | Medicaid | WI | |
483240 | Other | ILLINOIS MEDICARE |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | (Wisconsin) | Primary |
Life Balance Medical Center Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 5069 Edgemere Ct, Roscoe, IL 61073 Phone: 815-623-1013 Fax: 815-623-1017 | |