Provider Demographics
NPI:1497087175
Name:IN HOME MEDICAL GROUP LLC
Entity Type:Organization
Organization Name:IN HOME MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICCOLE
Authorized Official - Middle Name:N
Authorized Official - Last Name:RANZ
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:815-988-8500
Mailing Address - Street 1:4215 NEWBURG RD
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-6479
Mailing Address - Country:US
Mailing Address - Phone:815-988-8500
Mailing Address - Fax:815-977-5956
Practice Address - Street 1:4215 NEWBURG RD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-6479
Practice Address - Country:US
Practice Address - Phone:815-988-8500
Practice Address - Fax:815-977-5956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-05
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.003861363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty