Basic Information
| Provider Information | |||||||||
| NPI: | 1134293475 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ATG REHAB SPECIALISTS, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | REHAB SPECIALISTS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2070 LITTLE HILLS EXPY | ||||||||
| Address2: | |||||||||
| City: | SAINT CHARLES | ||||||||
| State: | MO | ||||||||
| PostalCode: | 633013708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3144477500 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 256 E HAMILTON AVE | ||||||||
| Address2: | SUITE C | ||||||||
| City: | CAMPBELL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950080237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4068985155 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2006 | ||||||||
| LastUpdateDate: | 07/24/2020 | ||||||||
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| AuthorizedOfficialLastName: | PIVAR | ||||||||
| AuthorizedOfficialFirstName: | JACK | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | GENERAL COUNSEL | ||||||||
| AuthorizedOfficialTelephone: | 5184750837 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 07/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332BC3200X | 101582 | CA | Y | Suppliers | Durable Medical Equipment & Medical Supplies | Customized Equipment |
ID Information
| ID | Type | State | Issuer | Description | 77-0121738 | 01 | CA | METRA-HEALTH | OTHER | 132576600 | 01 | CA | US DPT OF LABOR | OTHER | 297326885 | 01 | CA | STANFORD PRE PAID HEALTH | OTHER | DME00819G | 05 | CA | MEDICAID | DME02896F | 05 | CA | MEDICAID | 217216 | 01 | CA | HIGHMARK BLUE SHIELD | OTHER |