Healthcare Provider Details

I. General information

NPI: 1447207741
Provider Name (Legal Business Name): ROCKFORD GASTROENTEROLOGY ASSOCIATES, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 ROXBURY RD
ROCKFORD IL
61107-5075
US

IV. Provider business mailing address

401 ROXBURY RD
ROCKFORD IL
61107-5078
US

V. Phone/Fax

Practice location:
  • Phone: 815-397-7340
  • Fax: 815-397-7388
Mailing address:
  • Phone: 815-397-7340
  • Fax: 815-397-7388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number042004145
License Number StateIL

VIII. Authorized Official

Name: MS. NICCOLE RANZ
Title or Position: CEO
Credential: FNP-C
Phone: 815-397-7340