Basic Information
| Provider Information | |||||||||
| NPI: | 1538149364 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FEATHERSTONE CLINIC, S.C. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | EAR, NOSE, & THROAT ASSOCIATES OF ROCKFORD | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 698 FEATHERSTONE RD | ||||||||
| Address2: | |||||||||
| City: | ROCKFORD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 611076303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8153983277 | ||||||||
| FaxNumber: | 8159861448 | ||||||||
| Practice Location | |||||||||
| Address1: | 698 FEATHERSTONE RD | ||||||||
| Address2: | |||||||||
| City: | ROCKFORD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 611076303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8153983277 | ||||||||
| FaxNumber: | 8159861448 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MACMURCHY | ||||||||
| AuthorizedOfficialFirstName: | KIMBERLY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CONTRACTING AND CREDENTIALING | ||||||||
| AuthorizedOfficialTelephone: | 8153983277 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | IL | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.