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General NPI Number Information
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NPI Number | 1265732036
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Entity Type | Organization
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Legal Business Name | ROCKFORD NEUROMONITORING GROUP LLC
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Dates
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Enumeration Date | 10/27/2010
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Last Update Date | 11/08/2010
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Provider Practice Location Address
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Address Line | 1036 LUNDVALL AVE
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City | ROCKFORD
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State | IL
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Zip | 61107-3338
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Country | US
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Telephone | 815-408-0519
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Fax | 815-977-5149
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Provider Business Mailing Address
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Address Line | 1036 LUNDVALL AVE
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City | ROCKFORD
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State | IL
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Zip | 61107-3338
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Country | US
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Telephone | 815-408-0519
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Fax | 815-977-5149
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MR. JOHN EDWARD DRAGOS III
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Credential | R. EP T, CNIM
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Telephone | 815-408-0519
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZE0600X
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Taxonomy Name | Electroneurodiagnostic Specialist/Technologist
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License Number |
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License Number State |
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