Healthcare Provider Details

I. General information

NPI: 1366638751
Provider Name (Legal Business Name): MIDWEST SURGICAL CARE CENTER, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2007
Last Update Date: 09/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6451 E RIVERSIDE BLVD SUITE 103A
ROCKFORD IL
61114-4421
US

IV. Provider business mailing address

6451 E RIVERSIDE BLVD SUITE 103A
ROCKFORD IL
61114-4421
US

V. Phone/Fax

Practice location:
  • Phone: 815-639-9900
  • Fax: 815-639-9860
Mailing address:
  • Phone: 815-639-9900
  • Fax: 815-639-9860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. TODD CEVENE
Title or Position: CLINIC DIRECTOR
Credential: DC
Phone: 815-639-9900