Provider Demographics
NPI:1205812286
Name:RHYNE, SAMANTHA J (PAC)
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:J
Last Name:RHYNE
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:MS
Other - First Name:SAMANTHA
Other - Middle Name:J
Other - Last Name:ELLINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:5804 SOUTHSTONE DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27406-8716
Mailing Address - Country:US
Mailing Address - Phone:336-768-9535
Mailing Address - Fax:336-621-8374
Practice Address - Street 1:2704 HENRY ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-3633
Practice Address - Country:US
Practice Address - Phone:336-621-3777
Practice Address - Fax:336-621-8374
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103700363AS0400X
NC112304363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2762476Medicare ID - Type Unspecified
NC2762476AMedicare PIN
Q20849Medicare UPIN