Provider Demographics
NPI:1154328425
Name:ELECTRO DIAGNOSTIC MEDICINE AND REHABILITATION SPECIALISTS LLC
Entity Type:Organization
Organization Name:ELECTRO DIAGNOSTIC MEDICINE AND REHABILITATION SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMARS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:KILGORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-489-8000
Mailing Address - Street 1:10547 MONTGOMERY RD STE 700
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:OH
Mailing Address - Zip Code:45242-4418
Mailing Address - Country:US
Mailing Address - Phone:513-489-8000
Mailing Address - Fax:513-247-2782
Practice Address - Street 1:10547 MONTGOMERY RD
Practice Address - Street 2:STE 700
Practice Address - City:MONTGOMERY
Practice Address - State:OH
Practice Address - Zip Code:45242-4418
Practice Address - Country:US
Practice Address - Phone:513-489-8000
Practice Address - Fax:513-247-2782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-01
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0582669Medicaid
KY65938516Medicaid
OH9329371Medicare PIN
KY65938516Medicaid
OHCK5076Medicare PIN