Roth, Terry
Roth, Terry is an individual health care provider with primary practice located at 4920 East State St , Rockford IL 61108. He recently has only one registered license in Allopathic & Osteopathic Physicians / Neurology, which is considered as his primary health care specialty. Roth, Terry can be contacted via phone (815) 226-1906.Contact Information
Primary practice address
4920 East State St
Rockford IL 61108
Phone: (815) 226-1906
Fax: (815) 226-8474
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Neurology | 2084N0400X | 36059503 | Illinois |
Profile Details
| NPI number | 1215919816 |
|---|---|
| LBN Legal business name | Roth, Terry |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Nov 18th, 2005 |
| Last updated | May 22nd, 2008 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1215919816 | NPPES |
| Illinois | Other | 0010100550 | BCBS |
| Illinois | Other | 791133579 | BCBS |
| Illinois | Other | 009771 | BCBS |
| Illinois | MEDICAID | 036059503 | BCBS |
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