1306071899 NPI number — DR. TIMOTHY JAMES ROBERT RUST M.D.

Table of content: DR. TIMOTHY JAMES ROBERT RUST M.D. (NPI 1306071899)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306071899 NPI number — DR. TIMOTHY JAMES ROBERT RUST M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUST
Provider First Name:
TIMOTHY
Provider Middle Name:
JAMES ROBERT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1306071899
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/01/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5450 FRANTZ RD
Provider Second Line Business Mailing Address:
STE 360
Provider Business Mailing Address City Name:
DUBLIN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43016-4141
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-544-6155
Provider Business Mailing Address Fax Number:
614-544-6370

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
931 CHATHAM LN
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43221-2417
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-533-5500
Provider Business Practice Location Address Fax Number:
614-533-5593
Provider Enumeration Date:
05/27/2009

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: 2084N0400X , with the licence number:  35.121729 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0090343 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".