Provider Demographics
NPI:1386783199
Name:REZIN ORTHOPEDIC & SPORTS MEDICINE, SC
Entity type:Organization
Organization Name:REZIN ORTHOPEDIC & SPORTS MEDICINE, SC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-942-4875
Mailing Address - Street 1:1051 W US ROUTE 6
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MORRIS
Mailing Address - State:IL
Mailing Address - Zip Code:60450-3349
Mailing Address - Country:US
Mailing Address - Phone:815-942-4875
Mailing Address - Fax:815-942-5046
Practice Address - Street 1:16101 WEBER RD
Practice Address - Street 2:ADVANCED PHYSICIANS BUILDING
Practice Address - City:CREST HILL
Practice Address - State:IL
Practice Address - Zip Code:60435-8812
Practice Address - Country:US
Practice Address - Phone:815-836-2668
Practice Address - Fax:815-836-8799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty