1619901840 NPI number — PRETORIUS AND ROBLES M.D.'S

Table of content: (NPI 1619901840)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619901840 NPI number — PRETORIUS AND ROBLES M.D.'S

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRETORIUS AND ROBLES M.D.'S
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:
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:
1619901840
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/09/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4743 CORNELL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45241-2432
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-561-3797
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4743 CORNELL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45241-2432
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-561-3797
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PRETORIUS
Authorized Official First Name:
HAROLD
Authorized Official Middle Name:
THOMAS
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
513-561-3797

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  35.056690 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 31919 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RE0101X , with the licence number: 35.056690 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RE0101X , with the licence number: 31919 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207UN0902X , with the licence number: 35.056690 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0586094 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 31-1180985 . This is a "TAX ID # DR. ALAM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 22000000013351 . This is a "ANTHEMBLUECROSSBLUESHIELD" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 64-869316 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 167090543703 . This is a "HUMANA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: P2309187 . This is a "OXFORD" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 1137929 . This is a "WORKER'S COMPENSATION" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 56690 . This is a "CHOICECARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000013351 . This is a "ANTHEMHEALTHPLANSKENTUCKY" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 1205826732 . This is a "NPI PROVIDER NUMBER DR. ALAM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4100195 . This is a "AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0764589 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110069666 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 56690 . This is a "HMNANA/CHOICECARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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