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NPI Code Detail

MEDICARE: STONE RIDGE MEDICAL GROUP SC

MEDICARE: STONE RIDGE MEDICAL GROUP SC
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
1207Q00000XFamily Medicine Physician036091695IL
2363AM0700XMedical Physician Assistant085002304IL
3363L00000XNurse Practitioner209000908IL
4207Q00000XFamily Medicine Physician336053231IL

General Provider Information

NPI Number : 1306097894
Entity Type Code : Organization
Provider Name (Legal Business Name) : STONE RIDGE MEDICAL GROUP SC
Provider Business Mailing Address
First Line : 306 46TH AVE
Second Line :
City : EAST MOLINE
State : IL
Zip : 61244-4281
Country : US
Telephone Number : 309-796-2329
Fax Number : 309-796-1146
Provider Business Practice Location Address
First Line : 306 46TH AVE
Second Line :
City : EAST MOLINE
State : IL
Zip : 61244-4281
Country : US
Telephone Number : 309-796-2329
Fax Number : 309-796-1146
Authorized Official
Title or Position : PRESIDENT
Name : JAMES PETRE
Credential : MD
Telephone Number : 309-796-2329
Provider Enumeration Date : 10/02/2008
Last Update Date : 10/02/2008

Similar Medicare Providers

1619973989 — JAMES E PETRE MD
Practice Location Address:
306 46TH AVE
EAST MOLINE, IL
61244-4281
Practice Phone: 309-796-2329
Practice Fax: 309-796-1146
1134125164 — ANNE M PETRE MD
Practice Location Address:
306 46TH AVE
EAST MOLINE, IL
61244-4281
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Practice Fax: 309-796-1146
1073629473 — GENESIS HEALTH SYSTEM
Practice Location Address:
306 46TH AVE
EAST MOLINE, IL
61244-4281
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1407474463 — MADISON NICOLE STILLWELL PA-C
Practice Location Address:
306 46TH AVE
EAST MOLINE, IL
61244-4281
Practice Phone: 309-796-2329
Practice Fax:
1710647870 — JENNIFER WILKINSON APRN
Practice Location Address:
306 46TH AVE
EAST MOLINE, IL
61244-4281
Practice Phone: 309-796-2329
Practice Fax:
1679311617 — COURTNEY GARLAND BIBO DNP
Practice Location Address:
306 46TH AVE
EAST MOLINE, IL
61244-4281
Practice Phone: 309-796-2329
Practice Fax:

Directions to “STONE RIDGE MEDICAL GROUP SC ” Practice Location

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