1588781686 NPI number — KEY REHABILITATION INC

Table of content: (NPI 1588781686)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588781686 NPI number — KEY REHABILITATION INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KEY REHABILITATION 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:
1588781686
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/21/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1335 NW BROAD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MURFREESBORO
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37129-4428
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-896-6400
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 W AIRPORT DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARTHAGE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64836-3583
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-362-8704
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/23/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
IRWIN
Authorized Official First Name:
JANET
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
615-896-6400

Provider Taxonomy Codes

  • Taxonomy code: 208100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 273Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 130992 . This is a "MO BCBS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".