Provider Demographics
NPI:1104057736
Name:ROSS REHABILITATION P.C.
Entity type:Organization
Organization Name:ROSS REHABILITATION P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARRIE
Authorized Official - Middle Name:WEINER
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-341-0000
Mailing Address - Street 1:7301 JEFFERSON ST NE
Mailing Address - Street 2:SUITE E
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109
Mailing Address - Country:US
Mailing Address - Phone:505-341-0000
Mailing Address - Fax:505-341-1495
Practice Address - Street 1:7301 JEFFERSON ST NE
Practice Address - Street 2:SUITE E
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109
Practice Address - Country:US
Practice Address - Phone:505-341-0000
Practice Address - Fax:505-341-1495
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROSS REHABILITATION P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-07-30
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM93-377208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM06925Medicaid
NM06925Medicaid
NM073-52-5546Medicare PIN