Healthcare Provider Details

I. General information

NPI: 1922805878
Provider Name (Legal Business Name): BELOIT HEALTH SYSTEM, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2025
Last Update Date: 02/27/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 BACKHAWK BLVD
SOUTH BELOIT IL
61080
US

IV. Provider business mailing address

1701 BLACKHAWK BLVD
SOUTH BELOIT IL
61080
US

V. Phone/Fax

Practice location:
  • Phone: 815-389-2268
  • Fax: 815-525-4360
Mailing address:
  • Phone: 815-389-2268
  • Fax: 815-525-4350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: JULIA EGEBRECHT
Title or Position: DIRECTOR, REVENUE CYCLE
Credential:
Phone: 608-364-1615