1255396495 NPI number — STEVE ALLEN RHYNE CRNA

Table of content: STEVE ALLEN RHYNE CRNA (NPI 1255396495)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255396495 NPI number — STEVE ALLEN RHYNE CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RHYNE
Provider First Name:
STEVE
Provider Middle Name:
ALLEN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255396495
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/15/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1239 E MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARBONDALE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62901-3175
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-549-0721
Provider Business Mailing Address Fax Number:
618-529-0449

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 S 14TH STREET
Provider Second Line Business Practice Location Address:
SIH MEDICAL GROUP ANESTHESIOLOGY
Provider Business Practice Location Address City Name:
HERRIN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62948
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-942-2171
Provider Business Practice Location Address Fax Number:
618-351-4919
Provider Enumeration Date:
04/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  119499 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: 209005026 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 214881 . This is a "MEDICARE MULTISPECIALTY GROUP PTAN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 214881 . This is a "MULTISPECIALTY GROUP PTAN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 915080311 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 214881 . This is a "MULTI-SPECIALTY GROUP PTAN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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