1972558328 NPI number — KATRINA L ROBERSON-TRAMMELL MD

Table of content: KATRINA L ROBERSON-TRAMMELL MD (NPI 1972558328)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972558328 NPI number — KATRINA L ROBERSON-TRAMMELL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROBERSON-TRAMMELL
Provider First Name:
KATRINA
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1972558328
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/29/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 40480
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOBILE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36640-0480
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-410-5437
Provider Business Mailing Address Fax Number:
251-434-3802

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1601 CENTER ST
Provider Second Line Business Practice Location Address:
STE 1N
Provider Business Practice Location Address City Name:
MOBILE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36604-1512
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-410-5437
Provider Business Practice Location Address Fax Number:
251-434-3802
Provider Enumeration Date:
05/24/2006

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: 208000000X , with the licence number:  19407 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 51034793 . This is a "BLUE CROSS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 12-10138 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 009929255 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00120269 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1414336 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 257537000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000034793 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 257537000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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