Provider Demographics
NPI:1023062601
Name:REHABILITATION MEDICINE CLINIC, INC.
Entity type:Organization
Organization Name:REHABILITATION MEDICINE CLINIC, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:DOMINIC
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:SERPICO
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:630-588-7891
Mailing Address - Street 1:26W171 ROOSEVELT RD
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-6078
Mailing Address - Country:US
Mailing Address - Phone:630-588-7891
Mailing Address - Fax:630-462-5573
Practice Address - Street 1:26W171 ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-6078
Practice Address - Country:US
Practice Address - Phone:630-588-7891
Practice Address - Fax:630-462-5573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Not Answered261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL528860Medicare ID - Type UnspecifiedMEDICARE-SUBURBAN
IL528850Medicare ID - Type UnspecifiedMEDICARE-COOK-PSYCH
IL527520Medicare ID - Type UnspecifiedMEDICARE #-COOK
IL527640Medicare ID - Type UnspecifiedMEDICARE- SUBURBAN