1780789438 NPI number — MRS. ROBERTA M RHODES ARNP

Table of content: MRS. ROBERTA M RHODES ARNP (NPI 1780789438)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780789438 NPI number — MRS. ROBERTA M RHODES ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RHODES
Provider First Name:
ROBERTA
Provider Middle Name:
M
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCCONVILLE
Provider Other First Name:
ROBERTA
Provider Other Middle Name:
R
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1780789438
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/02/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3706 SW 6TH AVE
Provider Second Line Business Mailing Address:
STORMONT-VAIL WEST
Provider Business Mailing Address City Name:
TOPEKA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66606-2084
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-270-4630
Provider Business Mailing Address Fax Number:
785-270-4628

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3706 SW 6TH AVE
Provider Second Line Business Practice Location Address:
STORMONT-VAIL WEST
Provider Business Practice Location Address City Name:
TOPEKA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66606-2084
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-270-4630
Provider Business Practice Location Address Fax Number:
785-270-4628
Provider Enumeration Date:
09/14/2006

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: 163W00000X , with the licence number:  RN-13-38358-101 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: ARNP 74314 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100251470A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100251470F , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110661008 . This is a "MEDICARE PTAN" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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