Provider Demographics
NPI:1649271321
Name:EMG AND REHABILITATION ASSOC., INC.
Entity type:Organization
Organization Name:EMG AND REHABILITATION ASSOC., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:A/R SUPVERVISOR HIPAA OFFICE
Authorized Official - Prefix:MRS
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-895-7660
Mailing Address - Street 1:568 S CLEVELAND AVE
Mailing Address - Street 2:STE B
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-8959
Mailing Address - Country:US
Mailing Address - Phone:614-895-7660
Mailing Address - Fax:614-895-3795
Practice Address - Street 1:568 S CLEVELAND AVE
Practice Address - Street 2:STE B
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-8959
Practice Address - Country:US
Practice Address - Phone:614-895-7660
Practice Address - Fax:614-895-3795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-03
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0704723Medicaid
OH9278031Medicare PIN