1871997312 NPI number — KELLEY RHOADES NP

Table of content: SARAH NANCY HSU DO (NPI 1922628684)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871997312 NPI number — KELLEY RHOADES NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RHOADES
Provider First Name:
KELLEY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

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:
1871997312
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/13/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
950 BETHESDA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ZANESVILLE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43701-7507
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-450-1687
Provider Business Mailing Address Fax Number:
740-450-1693

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
945 BETHESDA DR
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
ZANESVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43701-0801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-454-4788
Provider Business Practice Location Address Fax Number:
740-450-6157
Provider Enumeration Date:
10/13/2014

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: 364SF0001X , with the licence number:  COA.16629-NP , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: COA.16629-NP . This is a "OHIO LICENSURE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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