Healthcare Provider Details

I. General information

NPI: 1508812611
Provider Name (Legal Business Name): ORTHOPAEDIC & ARTHRITIS CLINIC OF ROCKFORD LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 06/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1235 N MULFORD RD
ROCKFORD IL
61107-3879
US

IV. Provider business mailing address

6785 WEAVER RD STE D
ROCKFORD IL
61114-8055
US

V. Phone/Fax

Practice location:
  • Phone: 815-398-7755
  • Fax: 815-398-7762
Mailing address:
  • Phone: 815-637-8636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MARK E HASTINGS
Title or Position: PRESIDENT
Credential: MD
Phone: 920-451-8142