Provider Demographics
NPI:1467561670
Name:ALCORN REHAB SERVICES INC
Entity Type:Organization
Organization Name:ALCORN REHAB SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:662-284-4656
Mailing Address - Street 1:1708 E SHILOH RD
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-3635
Mailing Address - Country:US
Mailing Address - Phone:662-284-4656
Mailing Address - Fax:662-665-0836
Practice Address - Street 1:1708 E SHILOH RD
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-3635
Practice Address - Country:US
Practice Address - Phone:662-284-4656
Practice Address - Fax:662-665-0836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP2000X
MS5927860001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00123001Medicaid
MS3149357OtherBC/BS OF TN
MS=========OtherAHS
MS00123001Medicaid