1972572899 NPI number — GERALD P LUBERT O.D.

Table of content: GERALD P LUBERT O.D. (NPI 1972572899)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972572899 NPI number — GERALD P LUBERT O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUBERT
Provider First Name:
GERALD
Provider Middle Name:
P
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
O.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:
1972572899
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/08/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1932 ALCOA HWY
Provider Second Line Business Mailing Address:
STE 255
Provider Business Mailing Address City Name:
KNOXVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37920-1508
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-244-2030
Provider Business Mailing Address Fax Number:
865-684-1196

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1932 ALCOA HWY STE 255
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37920-1508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-244-2030
Provider Business Practice Location Address Fax Number:
865-684-1196
Provider Enumeration Date:
03/14/2006

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: 152WC0802X , with the licence number:  0943 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: 0943 , 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: 2240396 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3333333 . This is a "UMWA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 410030911 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5928759 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100026729 . This is a "PHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3599503 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 86314 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com