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General NPI Number Information
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NPI Number | 1154875573
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Entity Type | Organization
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Legal Business Name | CAREATC - L&P STERLING
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Dates
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Enumeration Date | 08/15/2016
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Last Update Date | 08/15/2016
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Provider Practice Location Address
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Address Line | 101 AVENUE K
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City | STERLING
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State | IL
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Zip | 61081-3229
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Country | US
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Telephone | 620-870-1727
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Fax |
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Provider Business Mailing Address
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Address Line | 101 AVENUE K
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City | STERLING
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State | IL
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Zip | 61081-3229
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF PURCHASING AND FACILITI
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Name | KEITH GUCWA
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Credential |
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Telephone | 918-779-7416
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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