Provider Demographics
NPI:1588893267
Name:INSTITUTE OF NEUROMUSCULAR MEDICINE AND REHABILITATION
Entity type:Organization
Organization Name:INSTITUTE OF NEUROMUSCULAR MEDICINE AND REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:S
Authorized Official - Last Name:DEW
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:616-866-8084
Mailing Address - Street 1:65 S MAIN ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-1286
Mailing Address - Country:US
Mailing Address - Phone:616-866-8084
Mailing Address - Fax:616-866-8085
Practice Address - Street 1:65 S MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-1286
Practice Address - Country:US
Practice Address - Phone:616-866-8084
Practice Address - Fax:616-866-8085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-02
Last Update Date:2010-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1740244193Medicaid
MI08-5-41-0248-5OtherBCBS PIN
MI08-5-41-0248-5OtherBCBS PIN