Provider Demographics
NPI:1780934166
Name:DIRECTCARE PHYSICIAN SERVICES, S.C.
Entity type:Organization
Organization Name:DIRECTCARE PHYSICIAN SERVICES, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:J
Authorized Official - Last Name:ECKBURG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-751-6316
Mailing Address - Street 1:7117 CRIMSON RIDGE DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-6213
Mailing Address - Country:US
Mailing Address - Phone:815-316-8700
Mailing Address - Fax:310-356-4935
Practice Address - Street 1:7117 CRIMSON RIDGE DR
Practice Address - Street 2:SUITE 3
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-6213
Practice Address - Country:US
Practice Address - Phone:815-633-8099
Practice Address - Fax:630-658-0543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-13
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty