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General NPI Number Information
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NPI Number | 1508913971
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Entity Type | Organization
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Legal Business Name | PEDIATRIC ASSOCIATES OF ROCKFORD
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Dates
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Enumeration Date | 01/05/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5727 STRATHMOOR DR SUITE 1
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City | ROCKFORD
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State | IL
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Zip | 61107-5180
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Country | US
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Telephone | 815-398-1527
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Fax | 815-398-1629
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Provider Business Mailing Address
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Address Line | 5727 STRATHMOOR DR SUITE 1
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City | ROCKFORD
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State | IL
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Zip | 61107-5180
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Country | US
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Telephone | 815-398-1527
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Fax | 815-398-1629
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN ALAN HART
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Credential | M.D.
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Telephone | 815-398-1527
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State | IL
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