MEDICARE: RANDY RHODES

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	363L00000X	Nurse Practitioner	SJ484684	OH

General Provider Information

NPI Number	:	1659819753
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANDY RHODES

Provider Business Mailing Address
First Line	:	1274 PLAINFIELD RD
Second Line	:
City	:	SOUTH EUCLID
State	:	OH
Zip	:	44121-2510
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1274 PLAINFIELD RD
Second Line	:
City	:	SOUTH EUCLID
State	:	OH
Zip	:	44121-2510
Country	:	US
Telephone Number	:	216-849-4952
Fax Number	:

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

Provider Enumeration Date	:	02/08/2017
Last Update Date	:	02/08/2017

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Directions to “ RANDY RHODES ” Practice Location

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