1871570648 NPI number — ROBERT S VENABLE M D

Table of content: ROBERT S VENABLE M D (NPI 1871570648)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871570648 NPI number — ROBERT S VENABLE M D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VENABLE
Provider First Name:
ROBERT
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M D
Provider Gender Code:
M

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:
1871570648
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/27/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2012 S PROMENADE BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROGERS
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72758-9073
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-616-1485
Provider Business Mailing Address Fax Number:
479-239-0536

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2012 S PROMENADE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROGERS
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72758-9073
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-616-1485
Provider Business Practice Location Address Fax Number:
479-239-0536
Provider Enumeration Date:
12/22/2005

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: 207P00000X , with the licence number:  036-077829 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X , with the licence number: ME 65943 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X , with the licence number: 16379 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X , with the licence number: C42512 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: C42512 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X , with the licence number: C5310 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 276256100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 036077829-2 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 036077829 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 036077829-4 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 26887 . This is a "BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1871570648 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 036077829-1 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 036077829 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200479270 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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