1437117561 NPI number — ROBERT STERLING HOLLABAUGH JR. M.D.

Table of content: JUSTIN M BIRKHIMER PA-C (NPI 1992677769)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437117561 NPI number — ROBERT STERLING HOLLABAUGH JR. M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOLLABAUGH
Provider First Name:
ROBERT
Provider Middle Name:
STERLING
Provider Name Prefix Text:
Provider Name Suffix Text:
JR.
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:
1437117561
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/28/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1325 WOLF PARK DR
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
GERMANTOWN
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38138-1742
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-252-3411
Provider Business Mailing Address Fax Number:
901-384-6422

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
125 GUTHRIE DR STE 102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTHAVEN
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38671-5829
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-349-1964
Provider Business Practice Location Address Fax Number:
901-763-4305
Provider Enumeration Date:
05/01/2006

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: 208800000X , with the licence number:  15804 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208800000X , with the licence number: 30313 , 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: 97879 . This is a "BLUE CROSS AR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 13137372 . This is a "PHCS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 133261 . This is a "HEALTH LINK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4025294 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0210025600 . This is a "QUAL CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3823224 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1201660 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3095141 . This is a "BLUE CROSS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 4574106 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".




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