# ORTHOMIDWEST SURGERY CENTER BELOIT, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1740918887
- **Authorized official:** LESLIE ELMER CPCS (DIRECTOR, CREDENTIALING AND RISK)
- **Authorized official phone:** (815) 381-7431

## Contact information

- **Practice address:** 2102 FREEMAN PARKWAY, BELOIT, WI 53511
- **Practice address phone:** (815) 398-9491
- **Mailing address:** 5875 E RIVERSIDE BLVD, ROCKFORD, IL 61114-4937
- **Mailing address phone:** (815) 381-7431

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 08/08/2022
- **Last updated:** 06/06/2023