Provider Demographics
NPI:1255396495
Name:RHYNE, STEVE ALLEN (CRNA)
Entity type:Individual
Prefix:
First Name:STEVE
Middle Name:ALLEN
Last Name:RHYNE
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1239 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901-3175
Mailing Address - Country:US
Mailing Address - Phone:618-549-0721
Mailing Address - Fax:618-529-0449
Practice Address - Street 1:201 S 14TH STREET
Practice Address - Street 2:SIH MEDICAL GROUP ANESTHESIOLOGY
Practice Address - City:HERRIN
Practice Address - State:IL
Practice Address - Zip Code:62948
Practice Address - Country:US
Practice Address - Phone:618-942-2171
Practice Address - Fax:618-351-4919
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO119499367500000X
IL209005026367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL214881OtherMEDICARE MULTISPECIALTY GROUP PTAN
IL214881OtherMULTISPECIALTY GROUP PTAN
MO915080311Medicaid
IL214881OtherMULTI-SPECIALTY GROUP PTAN
MO000060558Medicare PIN