| Sa Stateline Clinic | |
|
4282 E Rockton Rd Roscoe IL 61073 | |
| (779) 696-9000 | |
| Not Available |
| Full Name | Sa Stateline Clinic |
|---|---|
| Speciality | Family Medicine |
| Location | 4282 E Rockton Rd, Roscoe, Illinois |
| Authorized Official Name and Position | Don Daniels (VP) |
| Authorized Official Contact | 8159662084 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sa Stateline Clinic Po Box 78866 Milwaukee WI 53278-8866 Ph: () - | Sa Stateline Clinic 4282 E Rockton Rd Roscoe IL 61073 Ph: (779) 696-9000 |
| NPI Number | 1386054062 |
|---|---|
| Provider Enumeration Date | 05/02/2014 |
| Last Update Date | 07/12/2018 |
| Medicare PECOS PAC ID | 5799698346 |
|---|---|
| Medicare Enrollment ID | O20100930020512 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386054062 | NPI | - | NPPES |
| 082 | Other | IL | TRICARE SUFFIX # |
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