Provider Demographics
NPI:1831184654
Name:ROCKFORD RADIATION ONCOLOGY LTD
Entity type:Organization
Organization Name:ROCKFORD RADIATION ONCOLOGY LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SMOROWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-971-6188
Mailing Address - Street 1:320 N ALPINE RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-4975
Mailing Address - Country:US
Mailing Address - Phone:815-227-4520
Mailing Address - Fax:815-229-5441
Practice Address - Street 1:2400 N ROCKTON AVE
Practice Address - Street 2:DEPT RADIATION ONCOLOGY
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61103-3655
Practice Address - Country:US
Practice Address - Phone:815-971-6188
Practice Address - Fax:815-968-9677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
739780Medicare ID - Type Unspecified