MEDICARE: MR. JOHN CHARLES REHM IV

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	CSA0218871	NM
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1912542739
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN CHARLES REHM IV

Provider Business Mailing Address
First Line	:	114 W 11TH ST
Second Line	:
City	:	SILVER CITY
State	:	NM
Zip	:	88061-5136
Country	:	US
Telephone Number	:	575-388-1511
Fax Number	:	575-313-8236

Provider Business Practice Location Address
First Line	:	2924 N MANN DR
Second Line	:
City	:	SILVER CITY
State	:	NM
Zip	:	88061-5900
Country	:	US
Telephone Number	:	505-397-2011
Fax Number	:

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

Provider Enumeration Date	:	11/15/2019
Last Update Date	:	01/19/2023

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