Provider Demographics
NPI:1083643993
Name:REHAB MEDICAL OF LAS VEGAS, INC.
Entity Type:Organization
Organization Name:REHAB MEDICAL OF LAS VEGAS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGINLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-813-0205
Mailing Address - Street 1:6365 CASTLEPLACE DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-1901
Mailing Address - Country:US
Mailing Address - Phone:317-813-0205
Mailing Address - Fax:
Practice Address - Street 1:4780 W HARMON AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-5240
Practice Address - Country:US
Practice Address - Phone:702-248-6847
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2000137-424332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID5609770001Medicare NSC