Basic Information
| Provider Information | |||||||||
| NPI: | 1386814549 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ST. JOHN'S HOSPITAL REHAB SOUTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3631 S 6TH ST | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 627034777 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2175353685 | ||||||||
| FaxNumber: | 2175290988 | ||||||||
| Practice Location | |||||||||
| Address1: | 3631 S 6TH ST | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 627034777 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2175353685 | ||||||||
| FaxNumber: | 2175290988 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/04/2008 | ||||||||
| LastUpdateDate: | 12/22/2021 | ||||||||
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| AuthorizedOfficialLastName: | UMLAND | ||||||||
| AuthorizedOfficialFirstName: | STEVEN | ||||||||
| AuthorizedOfficialMiddleName: | JON | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 2178148880 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ST. JOHN'S HOSPITAL | ||||||||
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| NPICertificationDate: | 12/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 070004611 | IL | Y | Hospitals | General Acute Care Hospital |
No ID Information.