1760540926 NPI number — MATCH PLAY TENNIS CENTERS, INC.

Table of content: (NPI 1760540926)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760540926 NPI number — MATCH PLAY TENNIS CENTERS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MATCH PLAY TENNIS CENTERS, 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:
REC CENTER PHYSICAL THERAPY
Provider Other Organization Name Type Code:
3
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:
1760540926
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/27/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 COLLINS RD NE
Provider Second Line Business Mailing Address:
BLDG 154-100
Provider Business Mailing Address City Name:
CEDAR RAPIDS
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52498-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
319-295-8899
Provider Business Mailing Address Fax Number:
319-295-8833

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 COLLINS RD NE
Provider Second Line Business Practice Location Address:
BLDG 154-100
Provider Business Practice Location Address City Name:
CEDAR RAPIDS
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52498-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-295-8899
Provider Business Practice Location Address Fax Number:
319-295-8833
Provider Enumeration Date:
12/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FOX
Authorized Official First Name:
PAMELA
Authorized Official Middle Name:
W
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
319-295-8899

Provider Taxonomy Codes

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

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

  • Identifier: 1066154 . This is a "USAMCO GROUP NUMBER" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 37850 . This is a "WELLMARK GROUP NUMBER" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: F245873 . This is a "MIDLANDS CHOICE ID NUMBER" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 5747352 . This is a "FIRST HEALTH GROUP NUMBER" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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