1578588240 NPI number — ROBIN PAULEY GUNN PA-C

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 1578588240 NPI number — ROBIN PAULEY GUNN PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUNN
Provider First Name:
ROBIN
Provider Middle Name:
PAULEY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PAULEY
Provider Other First Name:
ROBIN
Provider Other Middle Name:
R.
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1578588240
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/05/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
929 BOWMAN RD
Provider Second Line Business Mailing Address:
STE 400
Provider Business Mailing Address City Name:
MOUNT PLEASANT
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29464-3237
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-730-4124
Provider Business Mailing Address Fax Number:
843-806-4295

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
929 BOWMAN RD STE 400
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MT PLEASANT
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29464-3237
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-730-4124
Provider Business Practice Location Address Fax Number:
843-806-4295
Provider Enumeration Date:
07/13/2006

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: 363A00000X , with the licence number:  PA2496 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AM0700X , with the licence number: PA2496 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: GP6337 . This is a "GROUP MEDICAID" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 2577PA , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1527331 . This is a "CIGNA PROVIDER ID" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 4949292 . This is a "AETNA PIN NO." identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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