University Clinic At Blackhawk

LBN: Board Of Trustees Of The University Of Illinois
University Clinic At Blackhawk is an health care organization with primary practice located at 330 15Th Ave , Rockford IL 61104-5155. The organization recently has only one registered license in Ambulatory Health Care Facilities / Student Health, which is considered as the primary health care specialty. Board Of Trustees Of The University Of Illinois can be contacted via phone (815) 395-5858, or through Sriram, Uma via phone (815) 395-5637.

Contact Information

Primary practice address
330 15Th Ave Rockford IL 61104-5155
Phone: (815) 395-5858
Fax: (815) 968-2035
Website:
Map and Directions
Authorized official contact:
Name: Sriram, Uma
Phone: (815) 395-5637

Health care specialties

SpecialtyCodeLicense #State
Ambulatory Health Care Facilities / Student Health 261QS1000X

Profile Details

NPI number 1255761961
LBN Legal business name Board Of Trustees Of The University Of Illinois
DBA Doing business as University Clinic At Blackhawk
Authorized official Sriram, Uma
Entity Organization
Organization subpart 1 No
Enumeration date Nov 15th, 2013
Last updated Apr 27th, 2016 - about 9 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1255761961 NPPES
Illinois MEDICAID PENDING

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