Healthcare Provider Details

I. General information

NPI: 1093152118
Provider Name (Legal Business Name): TRANSFORMATIONS CLINICAL ENTITY FLORIDA ILLINOIS AND OHIO SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2013
Last Update Date: 02/13/2026
Certification Date: 02/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5995 SPRING CREEK RD
ROCKFORD IL
61114-6481
US

IV. Provider business mailing address

5995 SPRING CREEK RD
ROCKFORD IL
61114-6481
US

V. Phone/Fax

Practice location:
  • Phone: 815-977-4403
  • Fax: 815-977-5796
Mailing address:
  • Phone: 815-977-4403
  • Fax: 815-977-5796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number036124349
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. SCOTT D CARTER
Title or Position: MANAGER
Credential:
Phone: 815-977-4403