MEDICARE: CITY OF SOUTH BELOIT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance	1416	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	590008426	OTHER	IL	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	10119295	OTHER	IL	BCBS

General Provider Information

NPI Number	:	1295768364
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF SOUTH BELOIT

Provider Business Mailing Address
First Line	:	519 BLACKHAWK BLVD STE 2
Second Line	:
City	:	SOUTH BELOIT
State	:	IL
Zip	:	61080-1977
Country	:	US
Telephone Number	:	847-577-8811
Fax Number	:	847-577-7967

Provider Business Practice Location Address
First Line	:	519 BLACKHAWK BLVD
Second Line	:
City	:	SOUTH BELOIT
State	:	IL
Zip	:	61080-1977
Country	:	US
Telephone Number	:	815-389-3023
Fax Number	:	815-389-8830

Authorized Official
Title or Position	:	FINANCE DIRECTOR
Name	:	DON ELLOIT
Credential	:
Telephone Number	:	815-389-3023

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	02/20/2026

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Directions to “CITY OF SOUTH BELOIT ” Practice Location

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