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General NPI Number Information
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NPI Number | 1366895294
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Entity Type | Organization
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Legal Business Name | ORTHOMIDWEST, PLLC
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Dates
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Enumeration Date | 07/15/2016
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Last Update Date | 01/20/2023
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Provider Practice Location Address
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Address Line | 330 E MAIN ST
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City | ROCKTON
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State | IL
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Zip | 61072-2501
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Country | US
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Telephone | 815-381-7431
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Fax | 815-381-7333
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Provider Business Mailing Address
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Address Line | 5875 E RIVERSIDE BLVD
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City | ROCKFORD
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State | IL
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Zip | 61114-4937
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Country | US
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Telephone | 815-381-7431
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Fax | 815-381-7333
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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Name | LESLIE ELMER
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Credential | CPCS
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Telephone | 815-381-7431
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 060010709
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License Number State | IL
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