Provider Demographics
NPI:1801072962
Name:SPENCE REHABILITATION CENTER, P.C.
Entity type:Organization
Organization Name:SPENCE REHABILITATION CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:SPENCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-513-2267
Mailing Address - Street 1:3737 45TH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IN
Mailing Address - Zip Code:46322-3008
Mailing Address - Country:US
Mailing Address - Phone:219-513-2267
Mailing Address - Fax:219-513-2267
Practice Address - Street 1:3737 45TH ST STE 1
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IN
Practice Address - Zip Code:46322-3008
Practice Address - Country:US
Practice Address - Phone:219-513-2267
Practice Address - Fax:219-510-5483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-18
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200885930AMedicaid
IN200885930AMedicaid
IN256050Medicare PIN