1275589889 NPI number — REHABILITATION PHYSICIANS GROUP LLC

Table of content: (NPI 1275589889)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275589889 NPI number — REHABILITATION PHYSICIANS GROUP LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REHABILITATION PHYSICIANS GROUP LLC
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:
1275589889
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/31/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 53904
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAFAYETTE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70505-3904
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-593-5420
Provider Business Mailing Address Fax Number:
337-593-5442

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5000 HENNESSY BLVD
Provider Second Line Business Practice Location Address:
REHAB UNIT
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70808-4375
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-765-8987
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GREEN
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
MARSHALL
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
225-765-8987

Provider Taxonomy Codes

  • Taxonomy code: 208100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1441694 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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