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General NPI Number Information
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NPI Number | 1386755700
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Entity Type | Organization
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Legal Business Name | FOREST CITY DIAGNOSTIC IMAGING LLC
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 06/12/2019
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Provider Practice Location Address
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Address Line | 735 N PERRYVILLE RD
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City | ROCKFORD
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State | IL
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Zip | 61107-6200
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Country | US
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Telephone | 815-398-1300
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Fax | 815-398-3797
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Provider Business Mailing Address
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Address Line | 735 N PERRYVILLE RD
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City | ROCKFORD
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State | IL
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Zip | 61107-6200
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Country | US
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Telephone | 815-398-1300
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Fax | 815-398-3797
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Authorized Official
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Title or Position | MANAGER
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Name | PATRICIA A WABICK
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Credential |
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Telephone | 708-675-1500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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