MEDICARE: RODNEY SANFORD HINES CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	R015475	SD
2	367500000X	Certified Registered Nurse Anesthetist	CR000164	SD

General Provider Information

NPI Number	:	1225082381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RODNEY SANFORD HINES CRNA

Provider Business Mailing Address
First Line	:	353 FAIRMONT BLVD
Second Line	:	ATTEN CHRISTIE MSS
City	:	RAPID CITY
State	:	SD
Zip	:	57701-7350
Country	:	US
Telephone Number	:	605-720-2020
Fax Number	:

Provider Business Practice Location Address
First Line	:	1440 N MAIN ST
Second Line	:
City	:	SPEARFISH
State	:	SD
Zip	:	57783-1505
Country	:	US
Telephone Number	:	605-644-4004
Fax Number	:	605-644-4006

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	01/23/2014

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