Provider Demographics
NPI:1265732036
Name:ROCKFORD NEUROMONITORING GROUP LLC
Entity type:Organization
Organization Name:ROCKFORD NEUROMONITORING GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:DRAGOS
Authorized Official - Suffix:III
Authorized Official - Credentials:R EP T, CNIM
Authorized Official - Phone:815-408-0519
Mailing Address - Street 1:1036 LUNDVALL AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-3338
Mailing Address - Country:US
Mailing Address - Phone:815-408-0519
Mailing Address - Fax:815-977-5149
Practice Address - Street 1:1036 LUNDVALL AVE
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-3338
Practice Address - Country:US
Practice Address - Phone:815-408-0519
Practice Address - Fax:815-977-5149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-27
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Single Specialty