Provider Demographics
NPI:1902854094
Name:RHOADS, SUSAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:RHOADS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 472
Mailing Address - Street 2:
Mailing Address - City:JENKINS
Mailing Address - State:KY
Mailing Address - Zip Code:41537-0472
Mailing Address - Country:US
Mailing Address - Phone:606-832-2171
Mailing Address - Fax:606-832-2943
Practice Address - Street 1:9480 HIGHWAY 805
Practice Address - Street 2:
Practice Address - City:JENKINS
Practice Address - State:KY
Practice Address - Zip Code:41537-8182
Practice Address - Country:US
Practice Address - Phone:606-832-2171
Practice Address - Fax:606-832-2943
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTP381207Q00000X
KY39904207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000715932OtherANTHEM - NICC
KY65904294Medicaid
KY000000715932OtherANTHEM - NICC
KYE17927Medicare UPIN
KYK003390Medicare PIN