1528097003 NPI number — ROLANDO TORRES MD

Table of content: ROLANDO TORRES MD (NPI 1528097003)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528097003 NPI number — ROLANDO TORRES MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TORRES
Provider First Name:
ROLANDO
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1528097003
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/03/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6691 JANES RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
APPLING
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30802-2312
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-833-9369
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 W HOSPITAL RD
Provider Second Line Business Practice Location Address:
DEPARTMENT OF EMERGENCY MEDICINE
Provider Business Practice Location Address City Name:
FORT GORDON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30905-5741
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-787-2264
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/30/2006

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: 207P00000X , with the licence number:  43138 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000897465A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001624 . This is a "BLUE CROSS" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: G43138 . This is a "SOUTH CAROLINA MEDICAID" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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