1700907565 NPI number — MRS. RHONDA FELECIA SMITH BASS CERTIFIED NURSE PRAC

Table of content: MRS. RHONDA FELECIA SMITH BASS CERTIFIED NURSE PRAC (NPI 1700907565)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700907565 NPI number — MRS. RHONDA FELECIA SMITH BASS CERTIFIED NURSE PRAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH BASS
Provider First Name:
RHONDA
Provider Middle Name:
FELECIA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CERTIFIED NURSE PRAC
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:
1700907565
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/30/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1101 LARONA RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TROTWOOD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45426
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-854-6514
Provider Business Mailing Address Fax Number:
937-708-5428

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2720 E 3RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAYTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45403-2102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-520-7889
Provider Business Practice Location Address Fax Number:
376-303-6039
Provider Enumeration Date:
04/02/2007

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:  210745 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: 210745 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 364SP0812X , with the licence number: RN.210745 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LC1500X , with the licence number: RN.210745 , 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: 328140 . This is a "ANTHEM BC" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2401047 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 492320001 . This is a "CARE SOURCE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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