Healthcare Provider Details

I. General information

NPI: 1740344522
Provider Name (Legal Business Name): REHAB MEDICAL OF ST. LOUIS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 10/25/2024
Certification Date: 10/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

924 HEMSATH RD
SAINT CHARLES MO
63303-5949
US

IV. Provider business mailing address

3750 PRIORITY WAY SOUTH DR
INDIANAPOLIS IN
46240-3831
US

V. Phone/Fax

Practice location:
  • Phone: 314-205-0070
  • Fax: 314-205-3021
Mailing address:
  • Phone: 317-436-6178
  • Fax: 855-671-9194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number102912
License Number StateMO

VIII. Authorized Official

Name: MR. PATRICK MCGINLEY
Title or Position: CEO
Credential:
Phone: 317-813-0205