Basic Information
| Provider Information | |||||||||
| NPI: | 1104903442 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ASSOCIATES IN REHABILITATION MEDICINE SC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4400 W 95TH ST STE 306 | ||||||||
| Address2: | |||||||||
| City: | OAK LAWN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604532659 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 0868454287 | ||||||||
| FaxNumber: | 7086842079 | ||||||||
| Practice Location | |||||||||
| Address1: | 4440 W 95TH ST | ||||||||
| Address2: | EMG LAB ROOM 042 SOUTH | ||||||||
| City: | OAK LAWN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604532600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7086845428 | ||||||||
| FaxNumber: | 7086842079 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2006 | ||||||||
| LastUpdateDate: | 12/15/2021 | ||||||||
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| AuthorizedOfficialLastName: | ADAIR | ||||||||
| AuthorizedOfficialFirstName: | ROY | ||||||||
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| AuthorizedOfficialTitleorPosition: | DELEGATED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 7086845428 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 12/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 01621490 | 01 | IL | BCBS PROVIDER ID | OTHER | 131667300 | 01 | IL | WORKERS COMPENSATION | OTHER | 47613 | 01 | IL | ADVOCATE HLTH PARTNERS ID | OTHER | CF1234 | 01 | IL | RAILROAD MEDICARE | OTHER |