=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528259629
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALLIED REHAB SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/05/2007
-----------------------------------------------------
Last Update Date | 08/05/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1620 BLOUNTVILLE BLVD
-----------------------------------------------------
City | BLOUNTVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37617-4701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-279-0002
-----------------------------------------------------
Fax | 423-279-0008
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1211
-----------------------------------------------------
City | BRISTOL
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37621-1211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-279-0002
-----------------------------------------------------
Fax | 423-279-0008
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. ROBERT L. MCILWAIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 423-279-0002
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------