Provider Demographics
NPI:1245489822
Name:REBUILDER MEDICAL TECHNOLOGIES OF NEVADA, INC.
Entity type:Organization
Organization Name:REBUILDER MEDICAL TECHNOLOGIES OF NEVADA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:B
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-585-8230
Mailing Address - Street 1:636 TREELINE DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:CHARLES TOWN
Mailing Address - State:WV
Mailing Address - Zip Code:25414-4700
Mailing Address - Country:US
Mailing Address - Phone:877-585-8230
Mailing Address - Fax:304-725-4915
Practice Address - Street 1:636 TREELINE DR
Practice Address - Street 2:SUITE B
Practice Address - City:CHARLES TOWN
Practice Address - State:WV
Practice Address - Zip Code:25414-4700
Practice Address - Country:US
Practice Address - Phone:877-585-8230
Practice Address - Fax:304-725-4915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-18
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001612860OtherBLUE CROSS BLUE SHIELD
WV001612860OtherBLUE CROSS BLUE SHIELD