Provider Demographics
NPI:1366477598
Name:HEALTH AND REHAB CLINIC, P.C.
Entity Type:Organization
Organization Name:HEALTH AND REHAB CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:MADHAVI
Authorized Official - Middle Name:REDDY
Authorized Official - Last Name:MUPPIDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:580-226-4400
Mailing Address - Street 1:1101 12TH AVE, NW
Mailing Address - Street 2:SUITE # 100
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401
Mailing Address - Country:US
Mailing Address - Phone:580-226-4400
Mailing Address - Fax:580-226-4410
Practice Address - Street 1:1101 12TH AVE NW
Practice Address - Street 2:SUITE # 100
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-5736
Practice Address - Country:US
Practice Address - Phone:580-226-4400
Practice Address - Fax:580-226-4410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK22554208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK02488974114Medicaid
OK100035370AMedicaid
OK02488974114Medicaid