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General NPI Number Information
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NPI Number | 1740918887
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Entity Type | Organization
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Legal Business Name | ORTHOMIDWEST SURGERY CENTER BELOIT, LLC
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Dates
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Enumeration Date | 08/08/2022
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Last Update Date | 06/06/2023
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Provider Practice Location Address
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Address Line | 2102 FREEMAN PARKWAY
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City | BELOIT
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State | WI
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Zip | 53511
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Country | US
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Telephone | 815-398-9491
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Fax |
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Provider Business Mailing Address
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Address Line | 5875 E RIVERSIDE BLVD
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City | ROCKFORD
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State | IL
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Zip | 61114-4937
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Country | US
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Telephone | 815-381-7431
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Fax |
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Authorized Official
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Title or Position | DIRECTOR, CREDENTIALING AND RISK
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Name | LESLIE ELMER
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Credential | CPCS
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Telephone | 815-381-7431
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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