Rockdale Blackhawk LLC

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

Legal business name

ROCKDALE BLACKHAWK LLC

Doing business as

Little River Healthcare Speciality Clinic

Practice address

1512 Leander Rd
Georgetown, TX 78628-8801

Phone

(512) 948-7611

NPI assigned

May 14, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jeffrey P Madison

Title

Ceo

Phone

(512) 446-4500

Specialties & licenses 1

Addresses

Other names 1

• Little River Healthcare Speciality Clinic Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1400025600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1400025600000",
    "number": "1073924932",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1512 LEANDER RD",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "786288801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1512 LEANDER RD",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "786288801",
            "telephone_number": "512-948-7611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROCKDALE BLACKHAWK LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-14",
        "last_updated": "2014-05-14",
        "status": "A",
        "authorized_official_last_name": "MADISON",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "512-446-4500"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Little River Healthcare Speciality Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Tiara Joy Rodgers, CPM

• Prosthetic/Orthotic Supplier in Georgetown, TX
• Providers in Georgetown, TX by specialty
• Prosthetic/Orthotic Supplier in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.