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STONE RIDGE MEDICAL GROUP SC NPI 1306097894


NPI Information

NPI: 1306097894
Provider Name: STONE RIDGE MEDICAL GROUP SC
Classification: Family Medicine - 207Q00000X
Entity Type: Organization

CLIA Number: 14D0946584

Address:
306 46TH AVE
EAST MOLINE, IL
ZIP 61244
Phone: (309) 796-2329
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STONE RIDGE MEDICAL GROUP SC is a family medicine in East Moline, IL. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. STONE RIDGE MEDICAL GROUP SC NPI is 1306097894. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

306 46TH AVE
EAST MOLINE, IL
ZIP 61244-281
Phone: (309) 796-2329
Fax: (309) 796-1146

The provider's authorized official is James Petre .
The authorized official title is President and has the following contact phone number (309) 796-2329.

The CLIA number assigned to this NPI record is 14D0946584 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 10/2/2008 and was last updated on 10/2/2008.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207Q00000XFamily Medicine036091695ILLINOISNo
2363AM0700XPhysician AssistantMedical085002304ILLINOISNo
3363L00000XNurse Practitioner209000908ILLINOISNo
4207Q00000XFamily Medicine336053231ILLINOISYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.