1760566194 NPI number — ROBERT G LEY CRNA

Table of content: ROBERT G LEY CRNA (NPI 1760566194)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760566194 NPI number — ROBERT G LEY CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEY
Provider First Name:
ROBERT
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760566194
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/14/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 440167
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37244-0167
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-620-2320
Provider Business Mailing Address Fax Number:
615-620-2323

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
315 OAK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LIVINGSTON
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38570-1728
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
931-738-9211
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/24/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  APN8639 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 163W00000X , with the licence number: RN29319 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4031889 . This is a "BC/BS OF TN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".