NPIMap

Organization Active NPI

Tina R. Entwistle, D.P.M., P.C.

  • Foot & Ankle Surgery Podiatrist
  • Rockford, IL
National Provider Identifier
1740463678
Registry record updated Jan 11, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
016-005194 Issued in IL
Legal business name
TINA R. ENTWISTLE, D.P.M., P.C.
Practice address
6778 Mill Rd
Suite 100
Rockford, IL 61108-2502
Phone
(815) 227-0041
NPI assigned
Dec 13, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2011

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

Authorized official

Name
Dr. Tina Renee Entwistle, D.P.M.
Title
President
Phone
(815) 227-0041

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213ES0103X 016-005194 IL Primary

Addresses

Primary practice location

6778 Mill Rd
Suite 100
Rockford, IL 61108-2502

Mailing address

6778 Mill Rd
Suite 100
Rockford, IL 61108-2502

Other names 1

  • Tina R. Entwistle, D.P.M., S.C. Former legal business name

National Provider Directory

National Provider Directory

Locations

4795 Manhattan Dr
Rockford, IL 61108
Phone (815) 227-0041

6778 Mill Rd
Ste 100
Rockford, IL 61108
Phone (815) 227-0041

NPI Registry JSON

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

{
    "created_epoch": "1197504000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1294704000000",
    "number": "1740463678",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6778 MILL RD",
            "address_2": "SUITE 100",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611082502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6778 MILL RD",
            "address_2": "SUITE 100",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611082502",
            "telephone_number": "815-227-0041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TINA R. ENTWISTLE, D.P.M., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-13",
        "last_updated": "2011-01-11",
        "status": "A",
        "authorized_official_last_name": "ENTWISTLE",
        "authorized_official_first_name": "TINA",
        "authorized_official_middle_name": "RENEE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "815-227-0041",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.P.M."
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "IL",
            "license": "016-005194",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tina R. Entwistle, D.P.M., S.C.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Rockford, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2011; 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.