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840 Blackhawk Blvd South Beloit IL 61080-2263 | |
(815) 395-5861 | |
(815) 395-5575 |
Full Name | |
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Speciality | Clinic/center - Student Health |
Location | 840 Blackhawk Blvd, South Beloit, Illinois |
Authorized Official Name and Position | Michael Harner (DIRECTOR OF FINANCIAL AFFAIRS) |
Authorized Official Contact | 8153955637 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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1601 Parkview Ave Rockford IL 61107-1822 Ph: (815) 395-5861 | 840 Blackhawk Blvd South Beloit IL 61080-2263 Ph: (815) 395-5861 |
NPI Number | 1871905190 |
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Provider Enumeration Date | 05/21/2014 |
Last Update Date | 05/21/2014 |
Identifier | Type | State | Issuer |
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1871905190 | NPI | - | NPPES |
PENDING | Medicaid | IL |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QS1000X | Clinic/center - Student Health | (* (Not Available)) | 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 | |