MEDICARE: GUIDING HEALTH IMMEDIATE & PRIMARY CARE, PLLC

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	261QC1500X	Community Health Clinic/Center
2	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1407571334
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GUIDING HEALTH IMMEDIATE & PRIMARY CARE, PLLC

Provider Business Mailing Address
First Line	:	2623 CHARLES ST FL 2
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61108-1608
Country	:	US
Telephone Number	:	773-407-5366
Fax Number	:

Provider Business Practice Location Address
First Line	:	2623 CHARLES ST FL 2
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61108-1608
Country	:	US
Telephone Number	:	773-407-5366
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ALEXANDRA MENDEZ
Credential	:	NP
Telephone Number	:	773-407-5366

Provider Enumeration Date	:	10/04/2022
Last Update Date	:	07/19/2023

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