MEDICARE: MR. OSCAR RAYNOMD GAIN JR. P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282N00000X	General Acute Care Hospital		IL

General Provider Information

NPI Number	:	1427176395
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. OSCAR RAYNOMD GAIN JR. P.T.

Provider Business Mailing Address
First Line	:	1105 FOREST HILL DR
Second Line	:
City	:	BELLEVILLE
State	:	IL
Zip	:	62221-4008
Country	:	US
Telephone Number	:	618-235-2639
Fax Number	:	618-235-2639

Provider Business Practice Location Address
First Line	:	1105 FOREST HILL DR
Second Line	:
City	:	BELLEVILLE
State	:	IL
Zip	:	62221-4008
Country	:	US
Telephone Number	:	618-235-2639
Fax Number	:	618-235-2639

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	07/08/2007

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