Provider Demographics
NPI:1134330194
Name:MIDWEST REHAB INC
Entity Type:Organization
Organization Name:MIDWEST REHAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZUBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-692-3405
Mailing Address - Street 1:485 MOXIE LANE
Mailing Address - Street 2:
Mailing Address - City:DELPHOS
Mailing Address - State:OH
Mailing Address - Zip Code:45833
Mailing Address - Country:US
Mailing Address - Phone:419-692-3405
Mailing Address - Fax:419-692-3401
Practice Address - Street 1:1200 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OH
Practice Address - Zip Code:45810-2616
Practice Address - Country:US
Practice Address - Phone:419-634-8655
Practice Address - Fax:419-634-0402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2187315Medicaid
OH2187315Medicaid