1194813865 NPI number — ERIN BESHEAR COBB OTRL

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194813865 NPI number — ERIN BESHEAR COBB OTRL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COBB
Provider First Name:
ERIN
Provider Middle Name:
BESHEAR
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OTRL
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BESHEAR
Provider Other First Name:
ERIN
Provider Other Middle Name:
RAE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
OTRL
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1194813865
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/27/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
514 S BROWN ST STE 600
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37172-2948
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-382-0500
Provider Business Mailing Address Fax Number:
615-382-0501

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
514 S BROWN ST
Provider Second Line Business Practice Location Address:
SUITE 600
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37172-2937
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-382-0500
Provider Business Practice Location Address Fax Number:
615-382-0501
Provider Enumeration Date:
10/10/2006

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: 225X00000X , with the licence number:  3432 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XP0200X , with the licence number: 3432 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1514286 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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