Basic Information
| Provider Information | |||||||||
| NPI: | 1366895294 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ROCKFORD ORTHOPEDIC ASSOCIATES, LTD. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5875 E RIVERSIDE BLVD | ||||||||
| Address2: | |||||||||
| City: | ROCKFORD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 611144937 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8153817431 | ||||||||
| FaxNumber: | 8153817333 | ||||||||
| Practice Location | |||||||||
| Address1: | 330 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | ROCKTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 610722501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8153817431 | ||||||||
| FaxNumber: | 8153817333 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2016 | ||||||||
| LastUpdateDate: | 07/15/2016 | ||||||||
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| AuthorizedOfficialLastName: | ELMER | ||||||||
| AuthorizedOfficialFirstName: | LESLIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 8153817431 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CPCS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | 060010709 | IL | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.