=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467103929
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEXT LEVEL MEDICAL CENTERS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/15/2022
-----------------------------------------------------
Last Update Date | 01/15/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2835 MCFARLAND RD STE D
-----------------------------------------------------
City | ROCKFORD
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61107-6819
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-708-6195
-----------------------------------------------------
Fax | 815-977-3182
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2835 MCFARLAND RD STE D
-----------------------------------------------------
City | ROCKFORD
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61107-6819
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-708-6195
-----------------------------------------------------
Fax | 815-977-3182
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | EMMETT BLAHNIK
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 815-708-6195
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------