1780918003 NPI number — MRS. LINDSEY KAYE ROBERSON P.T.

Table of content: MRS. LINDSEY KAYE ROBERSON P.T. (NPI 1780918003)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780918003 NPI number — MRS. LINDSEY KAYE ROBERSON P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROBERSON
Provider First Name:
LINDSEY
Provider Middle Name:
KAYE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HOWETH
Provider Other First Name:
LINDSEY
Provider Other Middle Name:
KAYE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1780918003
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/07/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1600 UNIVERSITY DR E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLLEGE STATION
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77840-2642
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
979-691-3300
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5101 MEDICAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78229-4801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-592-5332
Provider Business Practice Location Address Fax Number:
210-592-5491
Provider Enumeration Date:
09/21/2009

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: 225100000X , with the licence number:  1191523 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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