South Beloit Office

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

036126253 Issued in IL

Legal business name

SOUTH BELOIT OFFICE

Practice address

1407 Pate Plaza Dr
South Beloit, IL 61080-1431

Phone

(630) 219-2002

NPI assigned

Apr 3, 2012

Organization subpart

No

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

Authorized official

Name

Mr. Mubeen Saleem

Title

Biller

Phone

(224) 616-8645

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Dr Patel SC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Dr Patel SC

  • General Practice Physician
  • Rockford, IL
  • NPI 1952670911
  NPD tax ID

Locations

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

{
    "created_epoch": "1333411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1333411200000",
    "number": "1679839773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1407 PATE PLAZA DR",
            "city": "SOUTH BELOIT",
            "state": "IL",
            "postal_code": "610801431",
            "telephone_number": "630-219-2002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1407 PATE PLAZA DR",
            "city": "SOUTH BELOIT",
            "state": "IL",
            "postal_code": "610801431",
            "telephone_number": "630-219-2002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH BELOIT OFFICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-03",
        "last_updated": "2012-04-03",
        "status": "A",
        "authorized_official_last_name": "SALEEM",
        "authorized_official_first_name": "MUBEEN",
        "authorized_official_title_or_position": "BILLER",
        "authorized_official_telephone_number": "224-616-8645",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": "IL",
            "license": "036126253",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036-126253",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Reich Chiropractic Clinic PC
• Teresa Ann Sambrook, RN
• Nicole M Simpson, N.P.
• Catherine Jean Smith, M.A., CF-SLP
• Michelle Kay Smith, P.T.A.
• Stateline Chiropractic & Sports Injury Clinic SC
• Nic Stewart, SSP
• Christine Strange, DO
• The Board of Trustees of the University of Illinois
• Tera Wenner, BCBA

• All providers in South Beloit, IL
• General Practice Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2012; 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.