Provider Demographics
NPI:1417134701
Name:ROCKFORD REGIONAL SPECIALTY LAB
Entity Type:Organization
Organization Name:ROCKFORD REGIONAL SPECIALTY LAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:CRONIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-986-3757
Mailing Address - Street 1:973 FEATHERSTONE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-5912
Mailing Address - Country:US
Mailing Address - Phone:815-986-3737
Mailing Address - Fax:815-986-3748
Practice Address - Street 1:973 FEATHERSTONE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-5912
Practice Address - Country:US
Practice Address - Phone:815-986-3737
Practice Address - Fax:815-986-3748
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FERTILITY & REPRODUCTIVE ENDOCRINOLOGY SPECIALISTS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory