Organization
THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS
Active
Other names
University Clinic at South Beloit - Junior High
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL HARNER (DIRECTOR OF FINANCIAL AFFAIRS)
(815) 395-5637
Entity
Organization
Contact information
Practice address
840 BLACKHAWK BLVD, SOUTH BELOIT, IL 61080-2263
(815) 395-5861
(815) 395-5575
Mailing address
1601 PARKVIEW AVE, ROCKFORD, IL 61107-1822
(815) 395-5861
(815) 395-5575
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
05/21/2014
Last updated
05/21/2014
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