Provider Demographics
NPI:1427091198
Name:TRINITY REHABILITATION GROUP
Entity type:Organization
Organization Name:TRINITY REHABILITATION GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:E
Authorized Official - Last Name:BLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-935-2004
Mailing Address - Street 1:6048 S. SHERIDAN
Mailing Address - Street 2:SUITE E
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74145-9212
Mailing Address - Country:US
Mailing Address - Phone:918-935-2004
Mailing Address - Fax:918-895-7887
Practice Address - Street 1:6048 S. SHERIDAN
Practice Address - Street 2:SUITE E
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74145-9212
Practice Address - Country:US
Practice Address - Phone:918-935-2004
Practice Address - Fax:918-895-7887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QR0401X
OK261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK374511Medicare Oscar/Certification