Provider Demographics
NPI:1699780361
Name:STANLEY C. RHEAUME, DPM, PC
Entity type:Organization
Organization Name:STANLEY C. RHEAUME, DPM, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:RHEAUME
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:719-564-2391
Mailing Address - Street 1:1513 MOORE AVE
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81005-2346
Mailing Address - Country:US
Mailing Address - Phone:719-564-2391
Mailing Address - Fax:719-564-2393
Practice Address - Street 1:1513 MOORE AVE
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81005-2346
Practice Address - Country:US
Practice Address - Phone:719-564-2391
Practice Address - Fax:719-564-2393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO417213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO84655241Medicaid
COC56323Medicare PIN
CO56323Medicare ID - Type Unspecified
CO1070180001Medicare NSC