Provider Demographics
NPI:1083846703
Name:ADVANCED REHAB AND MEDICAL PC
Entity Type:Organization
Organization Name:ADVANCED REHAB AND MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHERRI
Authorized Official - Middle Name:U
Authorized Official - Last Name:BONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-664-6998
Mailing Address - Street 1:2012 GREYSTONE SQ
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-3575
Mailing Address - Country:US
Mailing Address - Phone:731-664-6998
Mailing Address - Fax:731-664-7161
Practice Address - Street 1:2012 GREYSTONE SQ
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-3575
Practice Address - Country:US
Practice Address - Phone:731-664-6998
Practice Address - Fax:731-664-7161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-13
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103G700321Medicare PIN
TN6416090001Medicare NSC