1760554430 NPI number — NORRIS REHAB CLINIC

Table of content: (NPI 1760554430)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760554430 NPI number — NORRIS REHAB CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORRIS REHAB CLINIC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760554430
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
920 TALON DR
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
O FALLON
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62269-1848
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-632-2000
Provider Business Mailing Address Fax Number:
618-632-2133

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
920 TALON DR
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
O FALLON
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62269-1848
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-632-2000
Provider Business Practice Location Address Fax Number:
618-632-2133
Provider Enumeration Date:
11/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NORRIS
Authorized Official First Name:
DARIN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
618-632-2000

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 627844 . This is a "UHC" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 5059553 . This is a "AETNA" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 8221298 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 888-329-5182 . This is a "GREAT WEST ACN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 58958 . This is a "GHP" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 58958 . This is a "CMR" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 114856 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 1472270 . This is a "FIRST HEALTH" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 382977 . This is a "HEALTHLINK" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 44-02250 . This is a "MEDICARE COMPLETE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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