MEDICARE: INDUSTRIAL REHABILITATION CENTER

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	261QM1300X	Multi-Specialty Clinic/Center

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1036280001	OTHER	WV	MEDICARE DMERC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881645695
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDUSTRIAL REHABILITATION CENTER

Provider Business Mailing Address
First Line	:	90 JACKSON PIKE
Second Line	:
City	:	GALLIPOLIS
State	:	OH
Zip	:	45631-1560
Country	:	US
Telephone Number	:	740-446-5387
Fax Number	:	740-446-5982

Provider Business Practice Location Address
First Line	:	313 MACCORKLE AVE SW
Second Line	:
City	:	SOUTH CHARLESTON
State	:	WV
Zip	:	25303-1263
Country	:	US
Telephone Number	:	304-744-2300
Fax Number	:	304-744-8195

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. VICKI L. RUSSELL-MASH
Credential	:
Telephone Number	:	740-446-5551

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	07/16/2009

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Directions to “INDUSTRIAL REHABILITATION CENTER ” Practice Location

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