1871604272 NPI number — CORBY REHABILITATION SERVICES, INC.

Table of content: (NPI 1871604272)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871604272 NPI number — CORBY REHABILITATION SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CORBY REHABILITATION SERVICES, INC.
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:
1871604272
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/21/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 399
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEELYVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47878-0399
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-442-7476
Provider Business Mailing Address Fax Number:
812-442-7545

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4018 WESTOAK VALLEY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LANESVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47136-9475
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-442-7476
Provider Business Practice Location Address Fax Number:
812-442-7545
Provider Enumeration Date:
08/31/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CORBY
Authorized Official First Name:
GARY
Authorized Official Middle Name:
ALAN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
812-442-7476

Provider Taxonomy Codes

  • Taxonomy code: 208100000X , with the licence number:  01045450A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000000360341 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: DD1727 . This is a "HEALTH NET FEDERAL SERVIC" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: DD1727 . This is a "TRICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200508870A . This is a "MEDICAID" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 607877400 . This is a "BLACK LUNG PROGRAM" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: DD1727 . This is a "PALMETTO TRICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".