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General NPI Number Information
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NPI Number | 1790189462
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Entity Type | Organization
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Legal Business Name | CENTER FOR SIGHT & HEARING
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Dates
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Enumeration Date | 10/09/2014
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Last Update Date | 10/09/2014
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Provider Practice Location Address
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Address Line | 8038 MACINTOSH LN
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City | ROCKFORD
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State | IL
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Zip | 61107-5300
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Country | US
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Telephone | 815-332-6800
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Fax |
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Provider Business Mailing Address
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Address Line | 8038 MACINTOSH LN
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City | ROCKFORD
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State | IL
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Zip | 61107-5300
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DIANE JONES
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Credential |
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Telephone | 815-332-6801
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 1053487942
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License Number State | IL
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