1942399662 NPI number — MRS. ROBIN M ZUMBERGE OTR/CHT

Table of content: MRS. ROBIN M ZUMBERGE OTR/CHT (NPI 1942399662)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942399662 NPI number — MRS. ROBIN M ZUMBERGE OTR/CHT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZUMBERGE
Provider First Name:
ROBIN
Provider Middle Name:
M
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
OTR/CHT
Provider Gender Code:
F

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:
1942399662
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/05/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 684986
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78768-4986
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-444-4263
Provider Business Mailing Address Fax Number:
512-444-4264

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1825 FORTVIEW RD
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78704-7654
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-444-4263
Provider Business Practice Location Address Fax Number:
512-444-4264
Provider Enumeration Date:
10/12/2006

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: 225X00000X , with the licence number:  108586 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225XH1200X , with the licence number: 104110579 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 8T7160 . This is a "BCBSTX PROVIDER NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8F22498 . This is a "MEDICARE PTAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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