1578562625 NPI number — SOUTHERN INDIANA REHABILITATION HOSPITAL

Table of content: (NPI 1578562625)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578562625 NPI number — SOUTHERN INDIANA REHABILITATION HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHERN INDIANA REHABILITATION HOSPITAL
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:
1578562625
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/28/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2587
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40201-2587
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-587-4099
Provider Business Mailing Address Fax Number:
502-587-4944

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3104 BLACKISTON BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW ALBANY
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47150-9579
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-941-8300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/20/2005

Additional Information

Authorized Official

Authorized Official Last Name:
NAPIER
Authorized Official First Name:
RANDY
Authorized Official Middle Name:
L
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
812-941-6106

Provider Taxonomy Codes

  • Taxonomy code: 283X00000X , with the licence number:  050062051 , 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: 1058292 . This is a "PASSPORT" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 2433921000 . This is a "PASSPORT ADVANTAGE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 030011100 . This is a "BLACK LUNG" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 1018454 . This is a "CHAMPUS" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200715810A . This is a "IN MEDICAID FOR SIRH FIRST STEPS GROUP" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 5000072 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000054356 . This is a "ANTHEM" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 129343300 . This is a "US DEPARTMENT OF LABOR" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200350290A . This is a "IN MEDICAID FOR SIRH GROUP" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200715810 . This is a "IN FIRST STEPS" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 01341718 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100368680A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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