1922264225 NPI number — BOB ROBERTSON, MNSC,RN,CS,PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922264225 NPI number — BOB ROBERTSON, MNSC,RN,CS,PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BOB ROBERTSON, MNSC,RN,CS,PC
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:
1922264225
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/08/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6369
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PARIS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75461-6245
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-782-9500
Provider Business Mailing Address Fax Number:
903-782-9550

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3605 N.E. LOOP 286
Provider Second Line Business Practice Location Address:
SUITE 2000
Provider Business Practice Location Address City Name:
PARIS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75460-5085
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-782-9500
Provider Business Practice Location Address Fax Number:
903-782-9550
Provider Enumeration Date:
08/06/2008

Additional Information

Authorized Official

Authorized Official Last Name:
ROBERTSON
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
R
Authorized Official Title or Position:
CLINICAL NURSE SPECIALIST
Authorized Official Telephone Number:
903-782-9500

Provider Taxonomy Codes

  • Taxonomy code: 364SP0809X , with the licence number:  569790 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0042RS . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 196224301 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com