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Organization
BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS
Active
Organization
BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS
Active
Other names
University Medical Services at Parkview
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. UMA SRIRAM (DIRECTOR OF FISCAL AFFAIRS)
(815) 395-5637
Entity
Organization
Contact information
Practice address
1601 PARKVIEW AVE, ROCKFORD, IL 61107-1822
(815) 395-5637
(815) 395-5887
Mailing address
1601 PARKVIEW AVE, ROCKFORD, IL 61107-1822
(815) 395-5637
(815) 395-5887
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
—
—
106H00000X
Marriage & Family Therapist
—
—
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
IL
Enumeration date
09/18/2014
Last updated
04/27/2016
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