1871597112 NPI number — MR. RODNEY ARTHUR GRIFFIS CRNA

Table of content: MR. RODNEY ARTHUR GRIFFIS CRNA (NPI 1871597112)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871597112 NPI number — MR. RODNEY ARTHUR GRIFFIS CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRIFFIS
Provider First Name:
RODNEY
Provider Middle Name:
ARTHUR
Provider Name Prefix Text:
MR.
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:
1871597112
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 474
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SYCAMORE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60178-0474
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-895-4850
Provider Business Mailing Address Fax Number:
815-899-1413

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1100 E NORRIS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OTTAWA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61350-1604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-433-3100
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/01/2005

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 , 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)





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