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NPI Code Detail

MEDICARE: VIRGIL CALVERT NURSING & REHABILITATION CENTER

MEDICARE: VIRGIL CALVERT NURSING & 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
1332BX2000XOxygen Equipment & Supplies (DME)0039651IL

General Provider Information

NPI Number : 1417122169
Entity Type Code : Organization
Provider Name (Legal Business Name) : VIRGIL CALVERT NURSING & REHABILITATION CENTER
Provider Business Mailing Address
First Line : 5050 SUMMIT AVE
Second Line :
City : EAST SAINT LOUIS
State : IL
Zip : 62203-1026
Country : US
Telephone Number : 847-982-2300
Fax Number : 847-982-2304
Provider Business Practice Location Address
First Line : 5050 SUMMIT AVE
Second Line :
City : EAST SAINT LOUIS
State : IL
Zip : 62203-1026
Country : US
Telephone Number : 847-982-2300
Fax Number : 847-982-2304
Authorized Official
Title or Position : COMPTROLLER
Name : MOE HERMAN
Credential :
Telephone Number : 847-982-2300
Provider Enumeration Date : 04/24/2008
Last Update Date : 04/24/2008

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Directions to “VIRGIL CALVERT NURSING & REHABILITATION CENTER ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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