1750312849 NPI number — TALLASSEE REHAB PC

Table of content: (NPI 1750312849)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750312849 NPI number — TALLASSEE REHAB PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TALLASSEE REHAB 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:
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:
1750312849
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/04/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 FRIENDSHIP RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TALLASSEE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36078-1265
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-283-8032
Provider Business Mailing Address Fax Number:
334-283-1136

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 FRIENDSHIP RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TALLASSEE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36078-1265
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-283-8032
Provider Business Practice Location Address Fax Number:
334-283-1136
Provider Enumeration Date:
07/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CRAIN
Authorized Official First Name:
JUSTIN
Authorized Official Middle Name:
Authorized Official Title or Position:
PT OWNER
Authorized Official Telephone Number:
334-283-8032

Provider Taxonomy Codes

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

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

  • Identifier: 1054269 . This is a "FIRST HEALTH" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 1487373 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 168028100 . This is a "US DEPT OF LABOR OWCP ACS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6410033 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 382573 . This is a "ACN GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 45311 . This is a "HEALTHSPRING OF AL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 529907700 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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