1740344522 NPI number — REHAB MEDICAL OF ST. LOUIS, LLC

Table of content: (NPI 1740344522)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740344522 NPI number — REHAB MEDICAL OF ST. LOUIS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REHAB MEDICAL OF ST. LOUIS, LLC
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:
1740344522
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/25/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3750 PRIORITY WAY SOUTH DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46240-3831
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-436-6178
Provider Business Mailing Address Fax Number:
855-671-9194

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
924 HEMSATH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT CHARLES
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63303-5949
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-205-0070
Provider Business Practice Location Address Fax Number:
314-205-3021
Provider Enumeration Date:
12/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCGINLEY
Authorized Official First Name:
PATRICK
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
317-813-0205

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  102912 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com