1306942412 NPI number — DR. ROBERT D REMKE OD

Table of content: DR. ROBERT D REMKE OD (NPI 1306942412)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306942412 NPI number — DR. ROBERT D REMKE OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REMKE
Provider First Name:
ROBERT
Provider Middle Name:
D
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD
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:
1306942412
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
250 N MILITARY AVE
Provider Second Line Business Mailing Address:
PO BOX 620
Provider Business Mailing Address City Name:
LAWRENCEBURG
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38464-3326
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
931-762-5595
Provider Business Mailing Address Fax Number:
931-766-2273

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
250 N MILITARY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAWRENCEBURG
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38464-3326
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
931-762-5595
Provider Business Practice Location Address Fax Number:
931-766-2273
Provider Enumeration Date:
09/15/2006

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: 152W00000X , with the licence number:  OD1171 , 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: 3596506 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 150348 . This is a "BCBS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: TN0102 . This is a "AMERICHOICE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 10066983 . This is a "AMERIGROUP" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 150348 . This is a "TNCARE SELECT" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 2240212 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 8842110 . This is a "CIGNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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