1881117901 NPI number — JOHN ROBERT ERWIN JR. ATC, LAT, PES, CES

Table of content: JOHN ROBERT ERWIN JR. ATC, LAT, PES, CES (NPI 1881117901)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881117901 NPI number — JOHN ROBERT ERWIN JR. ATC, LAT, PES, CES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ERWIN
Provider First Name:
JOHN
Provider Middle Name:
ROBERT
Provider Name Prefix Text:
Provider Name Suffix Text:
JR.
Provider Credential Text:
ATC, LAT, PES, CES
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:
1881117901
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1605 AVENUE OF CHAMPIONS
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOWLING GREEN
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42101-6412
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-745-3408
Provider Business Mailing Address Fax Number:
270-745-3409

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1605 AVENUE OF CHAMPIONS
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOWLING GREEN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42101-6412
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-745-3408
Provider Business Practice Location Address Fax Number:
270-745-3409
Provider Enumeration Date:
07/20/2017

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: 2255A2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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