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General NPI Number Information
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NPI Number | 1073679411
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Entity Type | Organization
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Legal Business Name | ROCKFORD SURGICAL SERVICE, S.C.
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Dates
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Enumeration Date | 12/29/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 5668 E STATE ST SUITE1000
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City | ROCKFORD
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State | IL
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Zip | 61108-2490
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Country | US
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Telephone | 815-397-7900
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Fax | 815-397-7919
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Provider Business Mailing Address
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Address Line | 5668 E STATE ST SUITE1000
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City | ROCKFORD
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State | IL
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Zip | 61108-2490
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Country | US
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Telephone | 815-397-7900
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Fax | 815-397-7919
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Authorized Official
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Title or Position | PRESIDENT
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Name | LESLIE P EDGCOMB
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Credential | M.D.
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Telephone | 815-397-7900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0102X
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Taxonomy Name | Surgical Critical Care Physician
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License Number | 04200060
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number |
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 208C00000X
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Taxonomy Name | Colon & Rectal Surgery Physician
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License Number |
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License Number State | IL
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Taxonomy #5
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number |
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License Number State | IL
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