Provider Demographics
NPI:1528141132
Name:PROMEDICAL REHAB GROUP INC
Entity type:Organization
Organization Name:PROMEDICAL REHAB GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TERRENCE
Authorized Official - Middle Name:B
Authorized Official - Last Name:WELSH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:740-354-3344
Mailing Address - Street 1:1611 27TH ST
Mailing Address - Street 2:BLDG. J. SUITE202
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-6931
Mailing Address - Country:US
Mailing Address - Phone:740-354-3344
Mailing Address - Fax:740-353-0585
Practice Address - Street 1:1611 27TH ST
Practice Address - Street 2:BLDG. J. SUITE202
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-6931
Practice Address - Country:US
Practice Address - Phone:740-354-3344
Practice Address - Fax:740-353-0585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35060023174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64869563Medicaid
OH0246755Medicaid
2492985OtherAETNA
000000039284OtherANTHEM
KY64869563Medicaid
000000039284OtherANTHEM
KY64869563Medicaid