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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 Clinic at Blackhawk
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
330 15TH AVE, ROCKFORD, IL 61104-5155
(815) 395-5858
(815) 968-2035
Mailing address
1601 PARKVIEW AVE, ROCKFORD, IL 61107-1822
(815) 385-5637
(815) 395-5887
Taxonomy
Speciality
Code
Description
License number
State
261QS1000X
Student Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
IL
Enumeration date
11/15/2013
Last updated
04/27/2016
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