Basic Information
| Provider Information | |||||||||
| NPI: | 1720155831 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | REGIONAL CARDIOLOGY CONSULTANTS, LTD. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6090 STRATHMOOR DR | ||||||||
| Address2: | SUITE 6 | ||||||||
| City: | ROCKFORD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 611076628 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8153950100 | ||||||||
| FaxNumber: | 8153950130 | ||||||||
| Practice Location | |||||||||
| Address1: | 5403 BULL VALLEY RD | ||||||||
| Address2: | |||||||||
| City: | MCHENRY | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600507410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8153440100 | ||||||||
| FaxNumber: | 8153440124 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2006 | ||||||||
| LastUpdateDate: | 08/13/2007 | ||||||||
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| AuthorizedOfficialLastName: | SCHLUND | ||||||||
| AuthorizedOfficialFirstName: | GRETCHEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8153950100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | IL | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Other Service Providers | Specialist | 174400000X | IL | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Other Service Providers | Specialist | 174400000X | IL | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 10100594 | 01 | IL | BCBS GROUP NUMBER | OTHER |