1821138397 NPI number — CLARA COBB M.D.

Table of content: (NPI 1790995488)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821138397 NPI number — CLARA COBB M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COBB
Provider First Name:
CLARA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1821138397
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/26/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
227 ARROWHEAD TRL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KINGSTON
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37763-7003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-376-4205
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
227 ARROWHEAD TRL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KINGSTON
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37763-7003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-376-4205
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/07/2007

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: 207ZP0102X , with the licence number:  MD18478 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 7525265 . This is a "CIGNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 134107 . This is a "BLACK LUNG" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 1520556 . This is a "UNITED MINE WORKERS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 220019758 . This is a "RR MEDICARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 76828 . This is a "PHP CARITEN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 62159 . This is a "SIGNATURE HEALTH ALLIANCE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 62-1658-77 . This is a "TAX ID#" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 100021685 . This is a "PHP TENNCARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3048821 . This is a "BLUE CROSS BLUE SHIELD TN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: HEALTHSOURCE . This is a "014F17649" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: MD18478 . This is a "MEDICAL LICENSE #" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 621658077 . This is a "CHAMPUS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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