Provider Demographics
NPI:1043337660
Name:ROCKFORD ORTHOPEDIC APPLIANCE CO
Entity Type:Organization
Organization Name:ROCKFORD ORTHOPEDIC APPLIANCE CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JORENE
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:MCFARLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-965-7759
Mailing Address - Street 1:422 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61104-1015
Mailing Address - Country:US
Mailing Address - Phone:815-965-7759
Mailing Address - Fax:815-965-9466
Practice Address - Street 1:422 E STATE ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61104-1015
Practice Address - Country:US
Practice Address - Phone:815-965-7759
Practice Address - Fax:815-965-9466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL=========001Medicaid