Provider Demographics
NPI:1508913971
Name:PEDIATRIC ASSOCIATES OF ROCKFORD
Entity Type:Organization
Organization Name:PEDIATRIC ASSOCIATES OF ROCKFORD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:HART
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-398-1527
Mailing Address - Street 1:5727 STRATHMOOR DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-5180
Mailing Address - Country:US
Mailing Address - Phone:815-398-1527
Mailing Address - Fax:815-398-1629
Practice Address - Street 1:5727 STRATHMOOR DR
Practice Address - Street 2:SUITE 1
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-5180
Practice Address - Country:US
Practice Address - Phone:815-398-1527
Practice Address - Fax:815-398-1629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty