Basic Information
| Provider Information | |||||||||
| NPI: | 1962476739 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RHODUS | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6 WAPITI LOOP | ||||||||
| Address2: | |||||||||
| City: | TAOS | ||||||||
| State: | NM | ||||||||
| PostalCode: | 875717124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5059476660 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1397 WEIMER RD | ||||||||
| Address2: | |||||||||
| City: | TAOS | ||||||||
| State: | NM | ||||||||
| PostalCode: | 875716253 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5757588883 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2006 | ||||||||
| LastUpdateDate: | 03/05/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | C-APN.0000892-C-CRNA | CO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 367500000X | R54743 | NM | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 10020355 | 01 | NM | LOVELACE HP | OTHER | 59332841 | 05 | CO | MEDICAID | T0426 | 05 | UT | MEDICAID | 956899 | 05 | AZ | MEDICAID | 202000353 | 01 | NM | PRESBYTERIAN HP | OTHER | NM006B15 | 01 | NM | BCBS | OTHER | 9829750 | 05 | NM | MEDICAID | P00329269 | 01 | NM | RR MEDICARE | OTHER |