MEDICARE: ROCKFORD CARDIOLOGY ASSOCIATES, LTD

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	207RC0000X	Cardiovascular Disease Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CB0709	OTHER	GA	RRMEDICARE

General Provider Information

NPI Number	:	1699775775
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROCKFORD CARDIOLOGY ASSOCIATES, LTD

Provider Business Mailing Address
First Line	:	444 ROXBURY ROAD
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61107-5059
Country	:	US
Telephone Number	:	815-398-3000
Fax Number	:	815-391-5096

Provider Business Practice Location Address
First Line	:	444 ROXBURY ROAD
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61107-5059
Country	:	US
Telephone Number	:	815-398-3000
Fax Number	:	815-391-5096

Authorized Official
Title or Position	:	CEO
Name	:	MR. JOHN SCHUSTER
Credential	:
Telephone Number	:	815-398-3000

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	02/22/2008

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