1588626337 NPI number — ROBIN M BUTLER RDH

Table of content: ROBIN M BUTLER RDH (NPI 1588626337)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588626337 NPI number — ROBIN M BUTLER RDH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUTLER
Provider First Name:
ROBIN
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RDH
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:
1588626337
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1001 WEST WORLEY
Provider Second Line Business Mailing Address:
FAMILY HEALTH CENTER OF BOONE COUNTY
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65203-2037
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-214-2314
Provider Business Mailing Address Fax Number:
573-442-5208

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 BUSINESS LOOP 70 WEST
Provider Second Line Business Practice Location Address:
FAMILY DENTAL CENTER, SUITE 216C
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-214-2314
Provider Business Practice Location Address Fax Number:
573-442-5208
Provider Enumeration Date:
04/06/2006

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: 124Q00000X , with the licence number:  2005015578 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1588626337 . This is a "NATIONAL PROVIDER IDENTIF" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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