Healthcare Provider Details

I. General information

NPI: 1447377510
Provider Name (Legal Business Name): JOHN R RINEHART RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 STATE ST BHN PSYCHIATRIC CRISIS SERVICES
SPRINGFIELD MA
01109
US

IV. Provider business mailing address

1234 BAY STREET
SPRINGFIELD MA
01109-2109
US

V. Phone/Fax

Practice location:
  • Phone: 413-733-6661
  • Fax: 413-733-7841
Mailing address:
  • Phone: 413-734-2020
  • Fax: 413-733-7841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number110319
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: