Basic Information
| Provider Information | |||||||||
| NPI: | 1578562625 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SOUTHERN INDIANA REHABILITATION HOSPITAL | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 2587 | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402012587 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025874099 | ||||||||
| FaxNumber: | 5025874944 | ||||||||
| Practice Location | |||||||||
| Address1: | 3104 BLACKISTON BLVD | ||||||||
| Address2: | |||||||||
| City: | NEW ALBANY | ||||||||
| State: | IN | ||||||||
| PostalCode: | 471509579 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8129418300 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2005 | ||||||||
| LastUpdateDate: | 08/28/2012 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | NAPIER | ||||||||
| AuthorizedOfficialFirstName: | RANDY | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 8129416106 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 283X00000X | 050062051 | IN | Y | Hospitals | Rehabilitation Hospital |
ID Information
| ID | Type | State | Issuer | Description | 1058292 | 01 | KY | PASSPORT | OTHER | 2433921000 | 01 | KY | PASSPORT ADVANTAGE | OTHER | 030011100 | 01 | IN | BLACK LUNG | OTHER | 1018454 | 01 | IN | CHAMPUS | OTHER | 200715810A | 01 | IN | IN MEDICAID FOR SIRH FIRST STEPS GROUP | OTHER | 5000072 | 01 | IN | UNITED HEALTHCARE | OTHER | 000000054356 | 01 | IN | ANTHEM | OTHER | 129343300 | 01 | IN | US DEPARTMENT OF LABOR | OTHER | 200350290A | 01 | IN | IN MEDICAID FOR SIRH GROUP | OTHER | 200715810 | 01 | IN | IN FIRST STEPS | OTHER | 01341718 | 05 | KY | MEDICAID | 100368680A | 05 | IN | MEDICAID |