1861731267 NPI number — TORRELL RHOADES HEARING SPECIALIST

Table of content: TORRELL RHOADES HEARING SPECIALIST (NPI 1861731267)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861731267 NPI number — TORRELL RHOADES HEARING SPECIALIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RHOADES
Provider First Name:
TORRELL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
HEARING SPECIALIST
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:
1861731267
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/19/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1101 MARLIN ST.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOLMEN
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54636
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-792-8353
Provider Business Mailing Address Fax Number:
507-457-9834

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1101 MARLIN ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOLMEN
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54636
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-792-8353
Provider Business Practice Location Address Fax Number:
507-457-9834
Provider Enumeration Date:
02/05/2013

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: 237700000X , with the licence number:  2593 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2593 . This is a "MINNESOTA CERTIFIED HEARING SPECIALIST" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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