1053382267 NPI number — SUSAN ANNE ROBINSON C-FNP

Table of content: SUSAN ANNE ROBINSON C-FNP (NPI 1053382267)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053382267 NPI number — SUSAN ANNE ROBINSON C-FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROBINSON
Provider First Name:
SUSAN
Provider Middle Name:
ANNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
C-FNP
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:
1053382267
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/15/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 927
Provider Second Line Business Mailing Address:
5 E. ALVON ROAD
Provider Business Mailing Address City Name:
WHITE SULPHUR SPRINGS
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
24986-2373
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-536-5030
Provider Business Mailing Address Fax Number:
304-536-5031

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
312 KING STREET
Provider Second Line Business Practice Location Address:
CENTRA SOUTHSIDE PROFESSIONAL LLC
Provider Business Practice Location Address City Name:
KEYSVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23937-3659
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-315-2998
Provider Business Practice Location Address Fax Number:
434-392-8191
Provider Enumeration Date:
01/27/2006

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: 363LF0000X , with the licence number:  NP-05484 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 17139457 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2367657 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 500027170 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 61459601 . This is a "BLACK LUNG/FECA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 021475C59 . This is a "VA PTAN NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 000000342755 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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