1194040337 NPI number — MR. TIMOTHY L ROBINSON CRNA

Table of content: MR. TIMOTHY L ROBINSON CRNA (NPI 1194040337)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194040337 NPI number — MR. TIMOTHY L ROBINSON CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROBINSON
Provider First Name:
TIMOTHY
Provider Middle Name:
L
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
CRNA
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:
1194040337
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/09/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1900 EXETER RD
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
GERMANTOWN
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38138-2954
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-818-2183
Provider Business Mailing Address Fax Number:
901-682-9522

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1900 EXETER RD
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
GERMANTOWN
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38138-2954
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-818-2160
Provider Business Practice Location Address Fax Number:
901-682-9522
Provider Enumeration Date:
03/31/2010

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: 163W00000X , with the licence number:  R369558 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: 15036 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1194040337 . This is a "CHAMPUS/HUMANA TRICARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 4265856 . This is a "BLUE CROSS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 04134808 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1521306 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 186246001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00886622 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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