Perryville Surgical Associates SC

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

Legal business name

PERRYVILLE SURGICAL ASSOCIATES SC

Practice address

535 Roxbury Rd
Rockford, IL 61107-5076

Phone

(815) 398-0175

Fax

(815) 398-9587

NPI assigned

Sep 15, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Kenneth W Mihelich, MD

Title

Secretary

Phone

(815) 398-0175

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Michael John Beierle MDSC Former legal business name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158278400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1305676800000",
    "number": "1154427664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "535 ROXBURY RD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611075076",
            "telephone_number": "815-398-0175",
            "fax_number": "815-398-9587"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "535 ROXBURY RD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611075076",
            "telephone_number": "815-398-0175",
            "fax_number": "815-398-9587"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERRYVILLE SURGICAL ASSOCIATES SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-15",
        "last_updated": "2011-05-18",
        "status": "A",
        "authorized_official_last_name": "MIHELICH",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "815-398-0175",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "0010100629",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "L011529",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Michael John Beierle MDSC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Matteo Perrone, MD
• Perry K. Tuneberg D.D.S. and Associates
• Cecily Devon Perry
• Perryville Counseling Group PLLC
• Perryville Dentist PC
• Julia R Pesavento, D.M.D.
• Petalber Therapy Services
• Catharin Peters, APRN
• Chloe Peters
• Kelly Anne Peters, DPT

• Surgery Physician in Rockford, IL
• Providers in Rockford, IL by specialty
• Surgery Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.