Healthcare Provider Details

I. General information

NPI: 1407818644
Provider Name (Legal Business Name): FREEPORT REGIONAL HEALTH CARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 10/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1163 W STEPHENSON ST
FREEPORT IL
61032-4866
US

IV. Provider business mailing address

421 W EXCHANGE ST PO BOX 268
FREEPORT IL
61032-4008
US

V. Phone/Fax

Practice location:
  • Phone: 815-599-7000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0203X
TaxonomyRadiation Oncology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL PERRY
Title or Position: CEO/PRESIDENT
Credential: MD
Phone: 815-599-7000