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NPI Code Detail

MEDICARE: STERLING ROCK FALLS CLINIC, LTD

MEDICARE: STERLING ROCK FALLS CLINIC, LTD
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
1204E00000XOral & Maxillofacial Surgery (D.M.D.)

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
19815737OTHERILBLUE CROSS/ BLUE SHIELD

General Provider Information

NPI Number : 1346475159
Entity Type Code : Organization
Provider Name (Legal Business Name) : STERLING ROCK FALLS CLINIC, LTD
Provider Business Mailing Address
First Line : 101 E MILLER RD
Second Line :
City : STERLING
State : IL
Zip : 61081-1252
Country : US
Telephone Number : 815-625-4790
Fax Number :
Provider Business Practice Location Address
First Line : 10 W 3RD ST
Second Line :
City : STERLING
State : IL
Zip : 61081-3503
Country : US
Telephone Number : 815-632-5300
Fax Number :
Authorized Official
Title or Position : PRES.-BOARD OF DIRECTORS
Name : DR. JEFFREY LEMAY
Credential : M.D.
Telephone Number : 815-625-4790
Provider Enumeration Date : 05/22/2009
Last Update Date : 05/22/2009

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