MEDICARE: FEATHERSTONE CLINIC, S.C.

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	174400000X	Specialist		IL

General Provider Information

NPI Number	:	1538149364
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FEATHERSTONE CLINIC, S.C.

Provider Business Mailing Address
First Line	:	698 FEATHERSTONE RD
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61107-6303
Country	:	US
Telephone Number	:	815-398-3277
Fax Number	:	815-986-1448

Provider Business Practice Location Address
First Line	:	698 FEATHERSTONE RD
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61107-6303
Country	:	US
Telephone Number	:	815-398-3277
Fax Number	:	815-986-1448

Authorized Official
Title or Position	:	CONTRACTING AND CREDENTIALING
Name	:	KIMBERLY MACMURCHY
Credential	:
Telephone Number	:	815-398-3277

Provider Enumeration Date	:	01/18/2006
Last Update Date	:	08/22/2020

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