Provider Demographics
NPI:1073605549
Name:INDUSTRIAL REHABILITATION CLINICS, PC
Entity Type:Organization
Organization Name:INDUSTRIAL REHABILITATION CLINICS, PC
Other - Org Name:IRC ROSWELL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:P
Authorized Official - Last Name:REEVE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:5057-977-6914
Mailing Address - Street 1:311 W COUNTRY CLUB RD
Mailing Address - Street 2:#1
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-5839
Mailing Address - Country:US
Mailing Address - Phone:505-622-6365
Mailing Address - Fax:505-627-0730
Practice Address - Street 1:311 W COUNTRY CLUB RD
Practice Address - Street 2:#1
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-5839
Practice Address - Country:US
Practice Address - Phone:505-622-6365
Practice Address - Fax:505-627-0730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty