MEDICARE: FREEPORT REGIONAL HEALTH CARE FOUNDATION

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1972647329
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FREEPORT REGIONAL HEALTH CARE FOUNDATION

Provider Business Mailing Address
First Line	:	421 W EXCHANGE ST
Second Line	:	PO BOX 268
City	:	FREEPORT
State	:	IL
Zip	:	61032-4030
Country	:	US
Telephone Number	:	815-599-7958
Fax Number	:

Provider Business Practice Location Address
First Line	:	1120 HEALTHCARE DR
Second Line	:
City	:	MOUNT CARROLL
State	:	IL
Zip	:	61053-1461
Country	:	US
Telephone Number	:	815-244-4181
Fax Number	:

Authorized Official
Title or Position	:	CEO PRESIDENT
Name	:	DR. MICHAEL PERRY
Credential	:	MD
Telephone Number	:	815-599-6000

Provider Enumeration Date	:	02/19/2007
Last Update Date	:	08/22/2020

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