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General NPI Number Information
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NPI Number | 1871926568
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Entity Type | Organization
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Legal Business Name | ROCKFORD ORTHOPEDIC ASSOCIATES, LTD.
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Dates
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Enumeration Date | 08/16/2013
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Last Update Date | 04/19/2024
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Provider Practice Location 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 | 815-381-7339
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Fax | 815-381-7333
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Provider Business Mailing Address
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Address Line | PO BOX 735263
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City | CHICAGO
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State | IL
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Zip | 60673-5263
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Country | US
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Telephone | 815-381-7339
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Fax | 815-381-7333
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Authorized Official
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Title or Position | MANAGER, MEDICAL STAFF SERVICES
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Name | MELISSA BOURGORD
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Credential | CPCS, CPMSM
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Telephone | 815-381-7339
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2471M1202X
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Taxonomy Name | Magnetic Resonance Imaging Radiologic Technologist
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License Number |
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License Number State |
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