1639291339 NPI number — EDWARD TODD ROBBINS M D PC

Table of content: DR. MIMOSA TIEUTHU TONNU N.D. (NPI 1710384375)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639291339 NPI number — EDWARD TODD ROBBINS M D PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EDWARD TODD ROBBINS M D PC
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:
1639291339
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6027 WALNUT GROVE RD
Provider Second Line Business Mailing Address:
SUITE 203
Provider Business Mailing Address City Name:
MEMPHIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38120-2145
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-761-9155
Provider Business Mailing Address Fax Number:
901-683-3915

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6027 WALNUT GROVE RD
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38120-2145
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-761-9155
Provider Business Practice Location Address Fax Number:
901-683-3915
Provider Enumeration Date:
04/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ROBBINS
Authorized Official First Name:
EDWARD
Authorized Official Middle Name:
TODD
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
901-761-9155

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  MD00011144 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 09015236 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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