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General NPI Number Information
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NPI Number | 1679695332
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Entity Type | Organization
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Legal Business Name | MEDISCAN IMAGING CENTER OF ROCKFORD LLC
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 10/16/2007
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Provider Practice Location Address
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Address Line | 6957 OLDE CREEK RD STE 4100
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City | ROCKFORD
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State | IL
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Zip | 61114-7416
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Country | US
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Telephone | 815-636-2244
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Fax | 815-633-0432
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Provider Business Mailing Address
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Address Line | 2415 CERRO VISTA DR
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City | ROCKFORD
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State | IL
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Zip | 61107-1004
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Country | US
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Telephone | 815-636-2244
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Fax | 815-633-0432
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. AVNEESH NIGAM
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Credential |
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Telephone | 815-636-2244
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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