Provider Demographics
NPI:1245239060
Name:REHAB SYSTEMS TWIN FALLS LLC
Entity Type:Organization
Organization Name:REHAB SYSTEMS TWIN FALLS LLC
Other - Org Name:COYOTE PROSTHETICS & ORTHOTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMIN MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:COLETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-342-4104
Mailing Address - Street 1:542 ADDISON AVE W
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-5039
Mailing Address - Country:US
Mailing Address - Phone:208-736-7330
Mailing Address - Fax:208-736-7332
Practice Address - Street 1:542 ADDISON AVE W
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-5039
Practice Address - Country:US
Practice Address - Phone:208-736-7330
Practice Address - Fax:208-736-7332
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REHAB SYSTEMS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-07-14
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010014274OtherBLUE SHIELD
ID86728OtherBLUE CROSS
ID002728200Medicaid
ID002728200Medicaid