Provider Demographics
NPI:1942473079
Name:SPECIALIZED PHYSICAL MEDICINE AND REHABILITIAN CLINICS PC
Entity Type:Organization
Organization Name:SPECIALIZED PHYSICAL MEDICINE AND REHABILITIAN CLINICS PC
Other - Org Name:SPR CLINICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALY
Authorized Official - Middle Name:MOHAMED
Authorized Official - Last Name:MOHSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:417-886-0310
Mailing Address - Street 1:520 W RIVENDALE DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65810-3122
Mailing Address - Country:US
Mailing Address - Phone:417-886-0310
Mailing Address - Fax:
Practice Address - Street 1:501 N MAIN ST
Practice Address - Street 2:SUIT C
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-3535
Practice Address - Country:US
Practice Address - Phone:417-343-1307
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-3715261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARA10451Medicare UPIN