1619081908 NPI number — BOBBIE ROBB NP

Table of content: BOBBIE ROBB NP (NPI 1619081908)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619081908 NPI number — BOBBIE ROBB NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROBB
Provider First Name:
BOBBIE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
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:
1619081908
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/09/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6584 W STATE ROAD 252
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EDINBURGH
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46124-9459
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2325 18TH ST
Provider Second Line Business Practice Location Address:
SUITE 130
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47201-5387
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-379-2020
Provider Business Practice Location Address Fax Number:
812-378-8267
Provider Enumeration Date:
08/17/2006

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: 363LF0000X , with the licence number:  71001393A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000000339226 . This is a "ANTHEM BCBS" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200400140 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 059917P . This is a "SIHO" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000990793 . This is a "ANTHEM PIN" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: P00100732 . This is a "PALMETTA GBA RAIROAD MC" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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