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General NPI Number Information
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NPI Number | 1245025071
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Entity Type | Organization
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Legal Business Name | ROCK RIVER FOOT AND ANKLE CLINIC SC
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Dates
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Enumeration Date | 04/11/2025
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Last Update Date | 04/11/2025
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Provider Practice Location Address
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Address Line | 422 SUMMIT AVE
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City | OCONOMOWOC
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State | WI
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Zip | 53066-3749
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Country | US
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Telephone | 262-490-4568
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 825159
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City | PHILADELPHIA
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State | PA
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Zip | 19182-5159
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Country | US
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Telephone | 866-626-1540
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Fax |
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Authorized Official
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Title or Position | REGIONAL CREDENTIALING SPECIALIST
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Name | ROSALIE KREIGHBAUM
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Credential |
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Telephone | 314-909-1920
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number |
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License Number State |
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