1588612006 NPI number — MICHAEL D BOBB JR. DO

Table of content: (NPI 1487373718)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588612006 NPI number — MICHAEL D BOBB JR. DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOBB
Provider First Name:
MICHAEL
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
JR.
Provider Credential Text:
DO
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:
1588612006
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/17/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
167 S MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROSEVILLE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43777-1284
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-697-7373
Provider Business Mailing Address Fax Number:
740-697-7683

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1010 COLLEGE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OXFORD
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27565-1284
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-690-3000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/05/2006

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: 207Q00000X , with the licence number:  2012-00926 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207Q00000X , with the licence number: 34008666 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1417932294 . This is a "GROUP NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0989499 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: CA0426 . This is a "GROUP MEDICARE PTAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2620597 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".