1497001234 NPI number — ROBIN JOHNSON

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 1497001234 NPI number — ROBIN JOHNSON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROBIN JOHNSON
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:
1497001234
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/30/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1515 KELLETT AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCHULENBURG
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78956-2251
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-906-5507
Provider Business Mailing Address Fax Number:
512-334-9900

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7901 CAMERON RD
Provider Second Line Business Practice Location Address:
BLDG 3 SUITE 326
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78754-3831
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-906-5507
Provider Business Practice Location Address Fax Number:
512-334-9900
Provider Enumeration Date:
07/30/2012

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
ROBIN
Authorized Official Middle Name:
Authorized Official Title or Position:
LABORATORY DIRECTOR
Authorized Official Telephone Number:
512-906-5507

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  45D2043244 , 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)





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