Provider Demographics
NPI:1568518322
Name:ROCHELLE COMMUNITY HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:ROCHELLE COMMUNITY HOSPITAL ASSOCIATION
Other - Org Name:MEDICAL GROUP OF ROCHELLE
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:TRACY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-562-3784
Mailing Address - Street 1:900 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:ROCHELLE
Mailing Address - State:IL
Mailing Address - Zip Code:61068-1764
Mailing Address - Country:US
Mailing Address - Phone:815-562-2181
Mailing Address - Fax:815-561-3120
Practice Address - Street 1:900 N 2ND ST STE 200
Practice Address - Street 2:
Practice Address - City:ROCHELLE
Practice Address - State:IL
Practice Address - Zip Code:61068-1764
Practice Address - Country:US
Practice Address - Phone:815-562-3784
Practice Address - Fax:815-561-3149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL07129930OtherBLUE SHIELD
IL07129930OtherBLUE SHIELD