1578652590 NPI number — TALBOT COUNTY COMMISSIONER OF ROADS & REVENUES

Table of content: ROBERT LYNN SORENSON M.D. (NPI 1235220799)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578652590 NPI number — TALBOT COUNTY COMMISSIONER OF ROADS & REVENUES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TALBOT COUNTY COMMISSIONER OF ROADS & REVENUES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1578652590
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 155
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TALBOTTON
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31827-0115
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-665-3456
Provider Business Mailing Address Fax Number:
706-665-2317

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1853 GENEVA HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TALBOTTON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31827-8542
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-665-3456
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WIMBERLY
Authorized Official First Name:
BETTY
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
706-665-3220

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  130-04 , 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: 000379211A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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