Provider Demographics
NPI:1013960665
Name:AZER REHAB SYSTEMS, P.C.
Entity Type:Organization
Organization Name:AZER REHAB SYSTEMS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LYTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-344-3400
Mailing Address - Street 1:872 W DAYTON ST
Mailing Address - Street 2:
Mailing Address - City:GALESBURG
Mailing Address - State:IL
Mailing Address - Zip Code:61401-1503
Mailing Address - Country:US
Mailing Address - Phone:309-344-3400
Mailing Address - Fax:309-344-5040
Practice Address - Street 1:872 W DAYTON ST
Practice Address - Street 2:
Practice Address - City:GALESBURG
Practice Address - State:IL
Practice Address - Zip Code:61401-1503
Practice Address - Country:US
Practice Address - Phone:309-344-3400
Practice Address - Fax:309-344-5040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2009-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209969Medicare ID - Type UnspecifiedWPS-MED B GROUP NUMBER
ILDC0793Medicare ID - Type UnspecifiedRAILROAD MEDICARE GOUP #