Provider Demographics
NPI:1275589889
Name:REHABILITATION PHYSICIANS GROUP LLC
Entity Type:Organization
Organization Name:REHABILITATION PHYSICIANS GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MARSHALL
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-765-8987
Mailing Address - Street 1:PO BOX 53904
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70505-3904
Mailing Address - Country:US
Mailing Address - Phone:337-593-5420
Mailing Address - Fax:337-593-5442
Practice Address - Street 1:5000 HENNESSY BLVD
Practice Address - Street 2:REHAB UNIT
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4375
Practice Address - Country:US
Practice Address - Phone:225-765-8987
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1441694Medicaid
LACJ4435Medicare PIN
LA5C920Medicare PIN