1073711297 NPI number — WEST BROAD INJURY & REHAB CENTER

Table of content: (NPI 1073711297)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073711297 NPI number — WEST BROAD INJURY & REHAB CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WEST BROAD INJURY & REHAB CENTER
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:
6
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:
1073711297
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/01/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7634 SLATE RIDGE BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
REYNOLDSBURG
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43068-8159
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-367-1203
Provider Business Mailing Address Fax Number:
614-367-1204

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7634 SLATE RIDGE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
REYNOLDSBURG
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43068-8159
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-367-1203
Provider Business Practice Location Address Fax Number:
614-367-1204
Provider Enumeration Date:
07/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SCHEETZ
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
P
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
614-367-1203

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  3331 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000000355650 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 13670065500 . This is a "OHIO BUREAU OF WORKERS CO" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 61129230 . This is a "OWCP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 11323783 . This is a "CAQH" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2353288 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7109596 . This is a "AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0000227811403 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 645548 . This is a "OPTUM HEALTH" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com