Basic Information
| Provider Information | |||||||||
| NPI: | 1649462938 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BELOIT COLLEGE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1905 HUEBBE PKWY | ||||||||
| Address2: | |||||||||
| City: | BELOIT | ||||||||
| State: | WI | ||||||||
| PostalCode: | 535111842 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6083641348 | ||||||||
| FaxNumber: | 6083642236 | ||||||||
| Practice Location | |||||||||
| Address1: | 700 COLLEGE ST | ||||||||
| Address2: | |||||||||
| City: | BELOIT | ||||||||
| State: | WI | ||||||||
| PostalCode: | 535115509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6083641348 | ||||||||
| FaxNumber: | 6083642236 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2007 | ||||||||
| LastUpdateDate: | 08/10/2007 | ||||||||
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| AuthorizedOfficialLastName: | GRAY | ||||||||
| AuthorizedOfficialFirstName: | RUTH | ||||||||
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| AuthorizedOfficialTitleorPosition: | ASSISTANT ADMINISTRATOR-OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 6083641348 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 363LA2200X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.