Basic Information
| Provider Information | |||||||||
| NPI: | 1215550496 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MIDLANDS REGIONAL REHABILITATION HOSPITAL LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5 EAST RIVER PARK PLACE E #460 | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937201560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5598922500 | ||||||||
| FaxNumber: | 5598922442 | ||||||||
| Practice Location | |||||||||
| Address1: | 20 PINNACLE PARKWAY | ||||||||
| Address2: | |||||||||
| City: | ELGIN | ||||||||
| State: | SC | ||||||||
| PostalCode: | 290458389 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8034388890 | ||||||||
| FaxNumber: | 8034388889 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2020 | ||||||||
| LastUpdateDate: | 05/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | FEGAN | ||||||||
| AuthorizedOfficialFirstName: | CLINT | ||||||||
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| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT/SECRETARY | ||||||||
| AuthorizedOfficialTelephone: | 7175915700 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 05/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 283X00000X | Y | Hospitals | Rehabilitation Hospital |
No ID Information.