Terry R Roth Md Pc | |
4920 E State St Rockford IL 61108-2272 | |
(815) 226-1906 | |
(815) 226-8474 |
Full Name | Terry R Roth Md Pc |
---|---|
Speciality | Clinic/center |
Location | 4920 E State St, Rockford, Illinois |
Authorized Official Name and Position | Terry R Roth (OWNER) |
Authorized Official Contact | 8152261906 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Terry R Roth Md Pc 4920 E State St Rockford IL 61108-2272 Ph: (815) 226-1906 | Terry R Roth Md Pc 4920 E State St Rockford IL 61108-2272 Ph: (815) 226-1906 |
NPI Number | 1265601579 |
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Provider Enumeration Date | 02/21/2008 |
Last Update Date | 06/25/2015 |
Identifier | Type | State | Issuer |
---|---|---|---|
1265601579 | NPI | - | NPPES |
10132303 | Other | IL | BCBS |
629800 | Other | IL | PTAN |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | (* (Not Available)) | Primary |
Gautam Gupta Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 6090 Strathmoor Dr, Suite #4, Rockford, IL 61107 Phone: 815-229-1899 Fax: 815-231-1218 | |
Rockford School District Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 401 N Gardiner Ave, Rockford, IL 61107 Phone: 815-398-3976 | |
Rockford Adult Medicine Associates S C Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 534 Roxbury Rd, Rockford, IL 61107 Phone: 815-381-7005 | |