MEDICARE: MEDISCAN IMAGING CENTER OF ROCKFORD LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician

General Provider Information

NPI Number	:	1679695332
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDISCAN IMAGING CENTER OF ROCKFORD LLC

Provider Business Mailing Address
First Line	:	2415 CERRO VISTA DR
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61107-1004
Country	:	US
Telephone Number	:	815-636-2244
Fax Number	:	815-633-0432

Provider Business Practice Location Address
First Line	:	6957 OLDE CREEK RD STE 4100
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61114-7416
Country	:	US
Telephone Number	:	815-636-2244
Fax Number	:	815-633-0432

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. AVNEESH NIGAM
Credential	:
Telephone Number	:	815-636-2244

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	10/16/2007

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