Provider Demographics
NPI:1578650784
Name:PHYSICAL MEDICINE AND REHABILITATION OF EAST CENTRAL INDIANA, PC
Entity type:Organization
Organization Name:PHYSICAL MEDICINE AND REHABILITATION OF EAST CENTRAL INDIANA, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:765-584-3665
Mailing Address - Street 1:910 E WASHINGTON ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:WINCHESTER
Mailing Address - State:IN
Mailing Address - Zip Code:47394-9221
Mailing Address - Country:US
Mailing Address - Phone:765-584-3665
Mailing Address - Fax:765-584-5604
Practice Address - Street 1:910 E WASHINGTON ST
Practice Address - Street 2:SUITE 3
Practice Address - City:WINCHESTER
Practice Address - State:IN
Practice Address - Zip Code:47394-9221
Practice Address - Country:US
Practice Address - Phone:765-584-3665
Practice Address - Fax:765-584-5604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-07
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01040142174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200167340AMedicaid
IN200167340AMedicaid
IN6354030001Medicare NSC