1053777052 NPI number — ENCORE PREAKNESS, INC.

Table of content: (NPI 1053777052)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053777052 NPI number — ENCORE PREAKNESS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ENCORE PREAKNESS, 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:
SELECT MEDICAL REHABILITATION SERVICES, INC.
Provider Other Organization Name Type Code:
4
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:
1053777052
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/22/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4025 TAMPA RD STE 1106
Provider Second Line Business Mailing Address:
LEGAL DEPT
Provider Business Mailing Address City Name:
OLDSMAR
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34677-3213
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-974-7878
Provider Business Mailing Address Fax Number:
727-726-1825

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13875 W 115TH TER
Provider Second Line Business Practice Location Address:
SMRS OFFICE
Provider Business Practice Location Address City Name:
OLATHE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66062-7937
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-906-0990
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/06/2016

Additional Information

Authorized Official

Authorized Official Last Name:
OLSEN
Authorized Official First Name:
SUE
Authorized Official Middle Name:
E
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
727-510-3850

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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