1194965012 NPI number — CARDIOVASCULAR INSTITUTE AT OSF, LLC

Table of content: (NPI 1194965012)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194965012 NPI number — CARDIOVASCULAR INSTITUTE AT OSF, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARDIOVASCULAR INSTITUTE AT OSF, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ROCKFORD CARDIOVASCULAR ASSOCIATES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194965012
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/28/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
444 ROXBURY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCKFORD
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61107-5059
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-398-3000
Provider Business Mailing Address Fax Number:
815-398-3041

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
444 ROXBURY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCKFORD
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61107-5059
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-398-3000
Provider Business Practice Location Address Fax Number:
815-398-3041
Provider Enumeration Date:
03/05/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MOORE
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
309-655-2850

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)