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1701 Blackhawk Blvd South Beloit IL 61080-2407 | |
(608) 364-1348 | |
(608) 364-2338 |
Full Name | |
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Speciality | Family Medicine |
Location | 1701 Blackhawk Blvd, South Beloit, Illinois |
Authorized Official Name and Position | Ruth Gray (ASSISTANT ADMINISTRATOR) |
Authorized Official Contact | 6083641348 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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1905 E Huebbe Pkwy Beloit WI 53511-1842 Ph: (608) 364-1348 | 1701 Blackhawk Blvd South Beloit IL 61080-2407 Ph: (608) 364-1348 |
NPI Number | 1346364718 |
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Provider Enumeration Date | 03/19/2007 |
Last Update Date | 08/22/2020 |
Identifier | Type | State | Issuer |
---|---|---|---|
1346364718 | NPI | - | NPPES |
32069700 | Medicaid | WI |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | (Wisconsin) | Primary |
South Beloit Office Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1407 Pate Plaza Dr, South Beloit, IL 61080 Phone: 630-219-2002 | |