Basic Information
| Provider Information | |||||||||
| NPI: | 1497087175 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | IN HOME MEDICAL GROUP LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4215 NEWBURG RD | ||||||||
| Address2: | |||||||||
| City: | ROCKFORD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 611086479 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8159888500 | ||||||||
| FaxNumber: | 8159775956 | ||||||||
| Practice Location | |||||||||
| Address1: | 4215 NEWBURG RD | ||||||||
| Address2: | |||||||||
| City: | ROCKFORD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 611086479 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8159888500 | ||||||||
| FaxNumber: | 8159775956 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2010 | ||||||||
| LastUpdateDate: | 01/20/2022 | ||||||||
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| AuthorizedOfficialLastName: | RANZ | ||||||||
| AuthorizedOfficialFirstName: | NICCOLE | ||||||||
| AuthorizedOfficialMiddleName: | N | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8159888500 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | FNP-BC | ||||||||
| NPICertificationDate: | 01/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 209.003861 | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.