| Rosecrance Ware Center | |
|
2704 N Main St Rockford IL 61103-3112 | |
| (815) 490-1600 | |
| (815) 490-1845 |
| Full Name | Rosecrance Ware Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 2704 N Main St, Rockford, Illinois |
| Authorized Official Name and Position | Samuel Miller (CEO/PRESIDENT) |
| Authorized Official Contact | 8154901737 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Rosecrance Ware Center 1200 W State St Rockford IL 61102-2112 Ph: (815) 490-1600 | Rosecrance Ware Center 2704 N Main St Rockford IL 61103-3112 Ph: (815) 490-1600 |
| NPI Number | 1922358373 |
|---|---|
| Provider Enumeration Date | 09/13/2012 |
| Last Update Date | 08/08/2023 |
| Medicare PECOS PAC ID | 5799682993 |
|---|---|
| Medicare Enrollment ID | O20231121000625 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922358373 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (Illinois) | Primary |
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