1063982064 NPI number — TRI CITY REHAB PHYSICIANS PLLC

Table of content: (NPI 1063982064)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063982064 NPI number — TRI CITY REHAB PHYSICIANS PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRI CITY REHAB PHYSICIANS PLLC
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:
1063982064
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/28/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
801 JOE MANN BLVD STE P-6
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDLAND
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48642-8900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-791-2455
Provider Business Mailing Address Fax Number:
989-791-1392

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4121 SHRESTHA DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAY CITY
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48706-2171
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-890-4322
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/03/2018

Additional Information

Authorized Official

Authorized Official Last Name:
NAHATA
Authorized Official First Name:
BABU
Authorized Official Middle Name:
Authorized Official Title or Position:
MD
Authorized Official Telephone Number:
989-890-4322

Provider Taxonomy Codes

  • Taxonomy code: 208100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com