1023064144 NPI number — EASTERN IOWA THERAPEUTICS PC

Table of content: (NPI 1023064144)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023064144 NPI number — EASTERN IOWA THERAPEUTICS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EASTERN IOWA THERAPEUTICS PC
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:
ACCELERATED REHABILITATION CENTERS
Provider Other Organization Name Type Code:
3
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:
1023064144
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
205 W WACKER DR
Provider Second Line Business Mailing Address:
SUITE 1020
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60606-1216
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2406 MOMENTUM PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60689-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-577-2480
Provider Business Practice Location Address Fax Number:
815-577-7535
Provider Enumeration Date:
05/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FRIESER
Authorized Official First Name:
RANDOLPH
Authorized Official Middle Name:
P
Authorized Official Title or Position:
PRESIDENT SECRETARY
Authorized Official Telephone Number:
312-640-0329

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  02757 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2251X0800X , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0429076 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0665026 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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