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Terry R Roth Md Pc
Clinic/Center in Rockford, Illinois
NPI 1265601579

Terry R Roth Md Pc is a Clinic/Center based in Rockford, IL. Terry R Roth Md Pc practices in Rockford, IL. The NPI Number for Terry R Roth Md Pc is 1265601579 and holds a License No. (Illinois).

The current practice location address for Terry R Roth Md Pc is 4920 E State St, Rockford, IL and can be reached out via phone at 815-226-1906 and via fax at 815-226-8474.

Location: 4920 E State St, Rockford, IL, 61108-2272
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1265601579
Provider Name
Terry R Roth Md Pc
Credential
Provider Entity Type
Organization
Address
4920 E State St, Rockford, IL, 61108-2272
Phone Number
815-226-1906
Fax Number
815-226-8474
Provider Enumeration Date
02/21/2008
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
10132303 01 IL BCBS
629800 01 IL PTAN
institution
Provider Business Practice Location Address Details
Address
4920 E State St
City
Rockford
State
Illinois
Zip
61108-2272
Phone Number
815-226-1906
Fax Number
815-226-8474
person
Provider Business Mailing Address Details
Address
4920 E State St
City
Rockford
State
Illinois
Zip
61108-2272
Phone Number
815-226-1906
Fax Number
815-226-8474
person
Provider's Taxonomy Details 1
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
-
Taxonomy
261Q00000X
License No.
()
Definition
A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).
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