Provider Demographics
NPI:1801934989
Name:NEUROMUSCULOSKELETAL REHABILITATION AND PAIN CLINIC, P.C.
Entity type:Organization
Organization Name:NEUROMUSCULOSKELETAL REHABILITATION AND PAIN CLINIC, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:BRADLEY
Authorized Official - Last Name:REIMER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:307-689-6277
Mailing Address - Street 1:600 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82716-4107
Mailing Address - Country:US
Mailing Address - Phone:307-689-6277
Mailing Address - Fax:
Practice Address - Street 1:646 JENNINGS AVE.
Practice Address - Street 2:STE #2
Practice Address - City:HOT SPRINGS
Practice Address - State:SD
Practice Address - Zip Code:57747
Practice Address - Country:US
Practice Address - Phone:605-745-5017
Practice Address - Fax:605-745-5017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD863261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD005435OtherBCBS PROVIDER #
SD0005434OtherBCBS GROUP #
NE100251560-00Medicaid
SD7604280Medicaid
SD0005434OtherBCBS GROUP #