Provider Demographics
NPI:1275690638
Name:TRI DOCTORS REHABILITATION GROUP PC
Entity Type:Organization
Organization Name:TRI DOCTORS REHABILITATION GROUP PC
Other - Org Name:COMPLETECARE MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC,R NCS T
Authorized Official - Phone:636-394-1200
Mailing Address - Street 1:11911 WESTLINE INDUSTRIAL DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-3200
Mailing Address - Country:US
Mailing Address - Phone:636-394-1200
Mailing Address - Fax:314-569-1623
Practice Address - Street 1:11911 WESTLINE INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63146-3200
Practice Address - Country:US
Practice Address - Phone:636-394-1200
Practice Address - Fax:314-569-1623
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRI DOCTOR REHABILITATION GROUP PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-03
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO107758OtherBLUE CROSS BLUE SHIELD
MO44 50059OtherUNITED HEALTH CARE
MO44 50059OtherUNITED HEALTH CARE