Basic Information
| Provider Information | |||||||||
| NPI: | 1780934166 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DIRECTCARE PHYSICIAN SERVICES, S.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7117 CRIMSON RIDGE DR | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | ROCKFORD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 611076213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8153168700 | ||||||||
| FaxNumber: | 3103564935 | ||||||||
| Practice Location | |||||||||
| Address1: | 7117 CRIMSON RIDGE DR | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | ROCKFORD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 611076213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8156338099 | ||||||||
| FaxNumber: | 6306580543 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2012 | ||||||||
| LastUpdateDate: | 10/31/2019 | ||||||||
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| AuthorizedOfficialLastName: | ECKBURG | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8157516316 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | 207Q00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.