Healthcare Provider Details

I. General information

NPI: 1801703921
Provider Name (Legal Business Name): ANTONIO RHAMES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ADDRESS: 729 REMINGTON ST,
FORT COLLINS CO
80525
US

IV. Provider business mailing address

2163 CUTTING HORSE DR APT 307
FORT COLLINS CO
80525-4188
US

V. Phone/Fax

Practice location:
  • Phone: 970-484-8427
  • Fax:
Mailing address:
  • Phone: 608-695-0334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: