Healthcare Provider Details

I. General information

NPI: 1790353753
Provider Name (Legal Business Name): BELOIT HEALTH SYSTEM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2021
Last Update Date: 07/07/2023
Certification Date: 07/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5605 E ROCKTON RD
ROSCOE IL
61073-7601
US

IV. Provider business mailing address

1905 E HUEBBE PKWY FL 5
BELOIT WI
53511-1842
US

V. Phone/Fax

Practice location:
  • Phone: 815-525-4000
  • Fax:
Mailing address:
  • Phone: 608-364-1615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code207WX0108X
TaxonomyUveitis and Ocular Inflammatory Disease (Ophthalmology) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: JAMES F BIRD
Title or Position: VICE PRESIDENT OF FINANCE/CFO
Credential: MBS, CPA
Phone: 608-364-5281