1598896326 NPI number — SPINAL REHAB CLINICS, PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598896326 NPI number — SPINAL REHAB CLINICS, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPINAL REHAB CLINICS, PA
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:
1598896326
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
225 N BENTON DR STE 110
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAUK RAPIDS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56379-1574
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
225 N BENTON DR STE 110
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAUK RAPIDS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56379-1575
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-252-2225
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CARLSON
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
T
Authorized Official Title or Position:
CEO PRESIDENT
Authorized Official Telephone Number:
320-252-2225

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 23823 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 636577900 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8B401SP . This is a "BLUECROSS AND BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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