1578608907 NPI number — MR. ROBERT H CARR RPH

Table of content: MR. ROBERT H CARR RPH (NPI 1578608907)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578608907 NPI number — MR. ROBERT H CARR RPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARR
Provider First Name:
ROBERT
Provider Middle Name:
H
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
RPH
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:
1578608907
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 547
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BASSFIELD
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39421-0547
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-943-6913
Provider Business Mailing Address Fax Number:
601-943-6327

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
345 GEN ROBERT E BLOUNT DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BASSFIELD
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39421
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-943-6913
Provider Business Practice Location Address Fax Number:
601-943-6327
Provider Enumeration Date:
02/21/2007

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: 183500000X , with the licence number:  E-7892 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2585959 . This is a "NCPDP #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00030433 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com