1740406164 NPI number — ORTHO-SPINE REHABILITATION CENTER

Table of content: DR. ERIC PAUL KENDALL MD (NPI 1386674976)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740406164 NPI number — ORTHO-SPINE REHABILITATION CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORTHO-SPINE REHABILITATION 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:
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:
1740406164
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/31/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7211 SAWMILL RD
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
DUBLIN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43016-5008
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-793-8817
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7211 SAWMILL RD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
DUBLIN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43016-5008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-793-8817
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CHOWDHURY
Authorized Official First Name:
TIM
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
614-389-8882

Provider Taxonomy Codes

  • Taxonomy code: 208VP0000X , with the licence number:  35080788 , 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: 2333951 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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