Provider Demographics
NPI:1689848798
Name:MILESTONE, INC.
Entity type:Organization
Organization Name:MILESTONE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & C.E.O.
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:P
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-639-2801
Mailing Address - Street 1:4060 MCFARLAND RD
Mailing Address - Street 2:
Mailing Address - City:LOVES PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61111-4402
Mailing Address - Country:US
Mailing Address - Phone:815-639-2805
Mailing Address - Fax:815-654-6444
Practice Address - Street 1:275 N PHELPS AVE
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2434
Practice Address - Country:US
Practice Address - Phone:815-484-8678
Practice Address - Fax:815-484-8680
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MILESTONE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty