Provider Demographics
NPI:1740218825
Name:FS ROCKFORD, INC
Entity Type:Organization
Organization Name:FS ROCKFORD, INC
Other - Org Name:FOOT SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:OPPERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-282-3500
Mailing Address - Street 1:6461 E RIVERSIDE BLVD
Mailing Address - Street 2:STE 105
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61114-4421
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6461 E RIVERSIDE BLVD
Practice Address - Street 2:STE 105
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61114-4421
Practice Address - Country:US
Practice Address - Phone:815-282-3500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2022-07-21
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
IL4805760001OtherDMERC
IL4805760001Medicare NSC