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NPI Code Detail

MEDICARE: MEDILODGE OF MONTROSE INC

MEDICARE: MEDILODGE OF MONTROSE INC
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
1314000000XSkilled Nursing Facility

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1932169521
Entity Type Code : Organization
Provider Name (Legal Business Name) : MEDILODGE OF MONTROSE INC
Provider Business Mailing Address
First Line : 7400 NEW LA GRANGE RD
Second Line : SUITE 100
City : LOUISVILLE
State : KY
Zip : 40222-4870
Country : US
Telephone Number : 502-429-8062
Fax Number : 502-429-0650
Provider Business Practice Location Address
First Line : 9317 VIENNA RD
Second Line :
City : MONTROSE
State : MI
Zip : 48457-9729
Country : US
Telephone Number : 810-639-6171
Fax Number : 810-639-7837
Authorized Official
Title or Position : CHIEF FINANCIAL OFFICER
Name : MR. STACEY PAUL ROGERS
Credential :
Telephone Number : 502-429-8062
Provider Enumeration Date : 03/27/2006
Last Update Date : 12/30/2014

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Directions to “MEDILODGE OF MONTROSE INC ” Practice Location

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