Organization Name: | ROCKFORD PAIN MANAGEMENT LTD |
NPI Number: | 1174885107 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | TODD CEVENE (OWNER) |
Mailing Address: | 6451 E Riverside Blvd Suite 101 Rockford |
State: | IL US |
Postal Code: | 611144421 |
Phone Number: | 8156391090 |
Fax Number: | 8156399860 |
NPI Enumeration Date: | 06/14/2012 |
NPI Last Update Date: | 06/14/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |