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Organization
MEDCHOICE MEDICAL CENTER LTD
Active
Organization
MEDCHOICE MEDICAL CENTER LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANTONIO R. BALUGA M.D. (MEDICAL DIRECTOR)
(815) 397-4142
Entity
Organization
Contact information
Practice address
6905 E STATE ST, ROCKFORD, IL 61108-2692
(815) 397-4142
(815) 397-4144
Mailing address
PO BOX 6107, ROCKFORD, IL 61125-1107
(815) 397-4142
(815) 307-4144
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
042-007683
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10120419
BLUE CROSS BLUE SHIELD
IL
01
—
146702
MEDICARE PART A
IL
01
—
447370
MEDICARE PART B
IL
Enumeration date
08/09/2005
Last updated
06/30/2010
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