Provider Demographics
NPI:1356412894
Name:ROCKFORD ORTHOPEDIC SURGERY CENTER, LLC
Entity type:Organization
Organization Name:ROCKFORD ORTHOPEDIC SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DON
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCHREINER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-398-9491
Mailing Address - Street 1:346 ROXBURY RD
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-5090
Mailing Address - Country:US
Mailing Address - Phone:815-381-7400
Mailing Address - Fax:
Practice Address - Street 1:346 ROXBURY RD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-5090
Practice Address - Country:US
Practice Address - Phone:815-381-7400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROCKFORD ORTHOPEDIC ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-13
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL7002835261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL210423Medicare ID - Type Unspecified