MEDICARE: BELOIT CLINIC 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
1	207R00000X	Internal Medicine Physician		WI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	483240	OTHER		ILLINOIS MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497879878
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BELOIT CLINIC SC

Provider Business Mailing Address
First Line	:	1905 HUEBBE PARKWAY
Second Line	:	BELOIT CLINIC SC
City	:	BELOIT
State	:	WI
Zip	:	53511-1842
Country	:	US
Telephone Number	:	608-364-2200
Fax Number	:	608-364-2338

Provider Business Practice Location Address
First Line	:	5605 EAST ROCKTON RD
Second Line	:	NORTH POINTE
City	:	ROSCOE
State	:	IL
Zip	:	61073-7601
Country	:	US
Telephone Number	:	815-525-4500
Fax Number	:	608-364-2338

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	WILLIAM P SULLIVAN
Credential	:	CEO
Telephone Number	:	608-364-2200

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	02/06/2008

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Directions to “BELOIT CLINIC SC ” Practice Location

Language	Start Address	Practice Location

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