Organization
MOBILITY CONNECTION, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROGER G. LICHTY (OWNER)
(815) 544-9600
Entity
Organization
Contact information
Practice address
4100 E. STATE STREET, ROCKFORD, IL 61108-2008
(815) 544-9600
(815) 544-5513
Mailing address
4100 E. STATE STREET, ROCKFORD, IL 61108-2008
(815) 544-9600
(815) 544-5513
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
203.000100
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10115182
BLUE CROSS OF ILLINOIS ID
IL
Enumeration date
08/19/2006
Last updated
09/04/2012
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