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EAR NOSE & THROAT SPECIALISTS OF ROCKFORD SC NPI 1740491745


NPI Information

NPI: 1740491745
Provider Name: EAR NOSE & THROAT SPECIALISTS OF ROCKFORD SC

Other Name: JAMES MELVIN SEVERSON

Classification: Preferred Provider Organization - 305R00000X
Entity Type: Organization
Address:
435 N MULFORD RD
SUITE 10
ROCKFORD, IL
ZIP 61107
Phone: (815) 399-5268
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EAR NOSE & THROAT SPECIALISTS OF ROCKFORD SC is a preferred provider organization in Rockford, IL. The provider is a group of physicians and/or hospitals who contract with an employer to provide services to their employees. In a PPO, the patient may got to the physician of his/her choice, even if that physician does not participate in the PPO, but the patient receives care at a lower benefit level. EAR NOSE & THROAT SPECIALISTS OF ROCKFORD SC NPI is 1740491745. The provider is registered as an organization entity type.
The provider Other Name Is James Melvin Severson.

The provider's business location address is:

435 N MULFORD RD
SUITE 10
ROCKFORD, IL
ZIP 61107-189
Phone: (815) 399-5268
Fax: (815) 399-3623

The provider's authorized official is James Melvin Severson .
The authorized official title is Medical Doctor and has the following contact phone number (815) 399-5268.

The enumeration date for this NPI number is 5/24/2007 and was last updated on 3/27/2012.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1305R00000XPreferred Provider Organization036067207ILLINOISYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1D93914MEDICARE UPINILLINOIS
2364350MEDICARE ID-TYPE UNSPECIFIEDILLINOIS
3036067207MEDICAIDILLINOIS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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