1538102215 NPI number — KINDRED REHAB SERVICES INC

Table of content: (NPI 1538102215)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538102215 NPI number — KINDRED REHAB SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KINDRED REHAB SERVICES 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:
BEDFORD OUTPATIENT THERAPY SPECIALISTS
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:
1538102215
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/10/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2137 16TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEDFORD
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47421-3003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-275-5593
Provider Business Mailing Address Fax Number:
812-275-5598

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2137 16TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEDFORD
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47421-3003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-275-5593
Provider Business Practice Location Address Fax Number:
812-275-5598
Provider Enumeration Date:
06/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WEAVER
Authorized Official First Name:
MARILYN
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
ASSISTANT SECRETARY
Authorized Official Telephone Number:
502-596-7300

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0401X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000000373957 . This is a "ANTHEM BILL ALLEN PT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 12418 . This is a "SIHO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 200731960 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000330128 . This is a "ANTHEM DEBBY TOTH OT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000373802 . This is a "ANTHEM MELINDA WELSCH OT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 200660710 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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