Healthcare Provider Details

I. General information

NPI: 1487012761
Provider Name (Legal Business Name): RAND MEDICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2016
Last Update Date: 02/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6030 GARRETT LN
ROCKFORD IL
61107-6637
US

IV. Provider business mailing address

PO BOX 7441
ROCKFORD IL
61126-7441
US

V. Phone/Fax

Practice location:
  • Phone: 815-226-1172
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number036.118933
License Number StateIL

VIII. Authorized Official

Name: RASHIDA RANDEREE
Title or Position: OWNER
Credential:
Phone: 302-245-6094