Provider Demographics
NPI:1417179730
Name:ELECTRODIAGNOSTIC REHAB ASSOC
Entity Type:Organization
Organization Name:ELECTRODIAGNOSTIC REHAB ASSOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHULZE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-222-3482
Mailing Address - Street 1:658 W. MARKET ST.
Mailing Address - Street 2:SUITE 117
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801-4697
Mailing Address - Country:US
Mailing Address - Phone:419-222-3482
Mailing Address - Fax:419-222-3668
Practice Address - Street 1:658 W. MARKET ST.
Practice Address - Street 2:SUITE 117
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-4697
Practice Address - Country:US
Practice Address - Phone:419-222-3482
Practice Address - Fax:419-222-3668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-06-9111J174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0184009Medicaid
OH0189326Medicaid
OH0290162Medicaid
OH0792171Medicare ID - Type UnspecifiedDR. HERNAN JIMENEZ-MEDINA
OH0792281Medicare ID - Type UnspecifiedDR. EVELYN JIMENEZ-MEDINA
OHE13321Medicare UPIN
OH0189326Medicaid