Provider Demographics
NPI:1720155831
Name:REGIONAL CARDIOLOGY CONSULTANTS, LTD.
Entity Type:Organization
Organization Name:REGIONAL CARDIOLOGY CONSULTANTS, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GRETCHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHLUND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-395-0100
Mailing Address - Street 1:6090 STRATHMOOR DR
Mailing Address - Street 2:SUITE 6
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-6628
Mailing Address - Country:US
Mailing Address - Phone:815-395-0100
Mailing Address - Fax:815-395-0130
Practice Address - Street 1:5403 BULL VALLEY RD
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-7410
Practice Address - Country:US
Practice Address - Phone:815-344-0100
Practice Address - Fax:815-344-0124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X, 174400000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL10100594OtherBCBS GROUP NUMBER
IL690280Medicare ID - Type Unspecified