Provider Demographics
NPI:1235243510
Name:M.H.R.C. INC.
Entity Type:Organization
Organization Name:M.H.R.C. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:FIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-633-5985
Mailing Address - Street 1:PO. BOX 15395
Mailing Address - Street 2:
Mailing Address - City:LOVES PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61132-5395
Mailing Address - Country:US
Mailing Address - Phone:815-633-5985
Mailing Address - Fax:815-633-5927
Practice Address - Street 1:5668 EAST STATE STREET
Practice Address - Street 2:#2500
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-3108
Practice Address - Country:US
Practice Address - Phone:815-633-5985
Practice Address - Fax:815-633-5927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071006307103TC0700X
IL036044184103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL204333Medicare ID - Type UnspecifiedMEDICARE
ILK21686Medicare ID - Type UnspecifiedMEDICARE
ILK18719Medicare ID - Type UnspecifiedMEDICARE
IL203051Medicare ID - Type UnspecifiedMEDICARE
IL260040265Medicare ID - Type UnspecifiedMEDICARE
ILK18306Medicare ID - Type UnspecifiedMEDICARE
ILK25884Medicare ID - Type UnspecifiedMEDICARE
IL205651Medicare ID - Type UnspecifiedMEDICARE
ILK27099Medicare ID - Type UnspecifiedMEDICARE