Provider Demographics
NPI:1821186578
Name:BIOMAX REHABILITATION SERVICES, INC
Entity Type:Organization
Organization Name:BIOMAX REHABILITATION SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:BORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BONUTTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-342-3412
Mailing Address - Street 1:PO BOX 1387
Mailing Address - Street 2:
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-1387
Mailing Address - Country:US
Mailing Address - Phone:217-342-5211
Mailing Address - Fax:217-540-7522
Practice Address - Street 1:1303 W EVERGREEN AVE
Practice Address - Street 2:STE 102
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-1619
Practice Address - Country:US
Practice Address - Phone:217-342-5211
Practice Address - Fax:217-540-7522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2515017OtherBLUE CROSS BLUE SHIELD
IL182801OtherHEALTHLINK
IL182801OtherHEALTHLINK
IL=========001Medicaid
IL4727880001Medicare NSC