| The Board Of Trustees Of The University Of Illinois | |
|
1221 E State St Rockford IL 61104-2231 | |
| (312) 413-3282 | |
| Not Available |
| Full Name | The Board Of Trustees Of The University Of Illinois |
|---|---|
| Speciality | Clinic/Center |
| Location | 1221 E State St, Rockford, Illinois |
| Authorized Official Name and Position | Henry Taylor (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 3124131261 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The Board Of Trustees Of The University Of Illinois 1220 S Wood St Chicago IL 60608-1202 Ph: (312) 413-3282 | The Board Of Trustees Of The University Of Illinois 1221 E State St Rockford IL 61104-2231 Ph: (312) 413-3282 |
| NPI Number | 1306486022 |
|---|---|
| Provider Enumeration Date | 01/10/2020 |
| Last Update Date | 01/10/2020 |
| Medicare PECOS PAC ID | 3072422716 |
|---|---|
| Medicare Enrollment ID | O20200224000612 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306486022 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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