Provider Demographics
NPI:1164464491
Name:INSTITUTE OF PHYSICAL MEDICINE AND REHABILITATION
Entity Type:Organization
Organization Name:INSTITUTE OF PHYSICAL MEDICINE AND REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:W
Authorized Official - Last Name:ZEHR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-692-8120
Mailing Address - Street 1:6501 N SHERIDAN RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-2932
Mailing Address - Country:US
Mailing Address - Phone:309-692-8110
Mailing Address - Fax:309-692-8673
Practice Address - Street 1:6501 N SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-2932
Practice Address - Country:US
Practice Address - Phone:309-692-8110
Practice Address - Fax:309-692-8673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILCK0900OtherMEDICARE RR
IL07223459OtherBC/BS OF ILLINOIS
IL166291OtherHEALTHLINK
IL07223459OtherBC/BS OF ILLINOIS
IL=========001MedicaidMEDICAID FOR PT
IL=========601MedicaidMEDICAID FOR OT/SP/DME
IL=========601Medicaid
IL1669416749Medicare Oscar/Certification
IL1790715092Medicare Oscar/Certification
IL144505Medicare Oscar/Certification
IL1124121371Medicare Oscar/Certification
IL675090Medicare PIN
IL=========001MedicaidMEDICAID FOR PT
IL1518902469Medicare Oscar/Certification