Basic Information
| Provider Information | |||||||||
| NPI: | 1639836679 | ||||||||
| EntityType: | 2 | ||||||||
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| 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 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1550 N RANDALL ROAD | ||||||||
| Address2: | |||||||||
| City: | ELGIN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 61023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8153989491 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/24/2021 | ||||||||
| LastUpdateDate: | 11/24/2021 | ||||||||
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| AuthorizedOfficialLastName: | ELMER | ||||||||
| AuthorizedOfficialFirstName: | LESLIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENITALING AND RISK MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8153817431 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 11/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
No ID Information.