Provider Demographics
NPI:1427004837
Name:MID AMERICAN SPORTS THERAPY AND REHABILITATION LLC
Entity Type:Organization
Organization Name:MID AMERICAN SPORTS THERAPY AND REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:REITER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-422-5526
Mailing Address - Street 1:PO BOX 239
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45839-0239
Mailing Address - Country:US
Mailing Address - Phone:419-422-5526
Mailing Address - Fax:419-422-5562
Practice Address - Street 1:1039 HASKINS RD
Practice Address - Street 2:SUITE L
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-9065
Practice Address - Country:US
Practice Address - Phone:419-353-8000
Practice Address - Fax:419-353-8001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2557424Medicaid
OH339234OtherANTHEM BCBS
OH2527108Medicaid
OH339234OtherANTHEM BCBS
OH2527108Medicaid