Provider Demographics
NPI:1134213077
Name:MIDWEST REHABILITATION INC
Entity type:Organization
Organization Name:MIDWEST REHABILITATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FACILITY DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:J
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MBA
Authorized Official - Phone:217-522-3380
Mailing Address - Street 1:614 N 6TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62702-5328
Mailing Address - Country:US
Mailing Address - Phone:217-522-3380
Mailing Address - Fax:217-522-3382
Practice Address - Street 1:614 N 6TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-5328
Practice Address - Country:US
Practice Address - Phone:217-522-3380
Practice Address - Fax:217-522-3382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL8432041OtherBCBS
IL211236Medicare ID - Type UnspecifiedOCCUPATIONAL THERAPY
IL8432041OtherBCBS