| Board Of Trustees Of The University Of Illinois | |
|
330 15th Ave Rockford IL 61104-5155 | |
| (815) 395-5858 | |
| (815) 968-2035 |
| Full Name | Board Of Trustees Of The University Of Illinois |
|---|---|
| Speciality | Clinic/center - Student Health |
| Location | 330 15th Ave, Rockford, Illinois |
| Authorized Official Name and Position | Uma Sriram (DIRECTOR OF FISCAL AFFAIRS) |
| Authorized Official Contact | 8153955637 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Board Of Trustees Of The University Of Illinois 1601 Parkview Ave Rockford IL 61107-1822 Ph: (815) 385-5637 | Board Of Trustees Of The University Of Illinois 330 15th Ave Rockford IL 61104-5155 Ph: (815) 395-5858 |
| NPI Number | 1255761961 |
|---|---|
| Provider Enumeration Date | 11/15/2013 |
| Last Update Date | 04/27/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255761961 | NPI | - | NPPES |
| PENDING | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QS1000X | Clinic/center - Student Health | (* (Not Available)) | Primary |
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