1992899405 NPI number — ROBERT W BIENERT CRNA

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992899405 NPI number — ROBERT W BIENERT CRNA

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

BIENERT

Provider First Name:

ROBERT

Provider Middle Name:

W

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

CRNA

Provider Gender Code:

M

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:

1992899405

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

02/20/2017

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 650865

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

DALLAS

Provider Business Mailing Address State Name:

TX

Provider Business Mailing Address Postal Code:

75265-0865

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

972-233-1999

Provider Business Mailing Address Fax Number:

972-233-3666

Provider First Line Business Practice Location Address:

1500 CITYWEST BLVD

Provider Second Line Business Practice Location Address:

STE. 300

Provider Business Practice Location Address City Name:

HOUSTON

Provider Business Practice Location Address State Name:

TX

Provider Business Practice Location Address Postal Code:

77042-2300

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

713-620-4000

Provider Business Practice Location Address Fax Number:

713-458-4229

Provider Enumeration Date:

10/02/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 367500000X , with the licence number:  RN88371 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 367500000X , with the licence number: AP120178 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 8340UE . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 8667UM . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: P01304452 . This is a "RAIL ROAD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 280840405 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
• Identifier: 280840406 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
• Identifier: TIN PLUS 015 . This is a "TRICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 1156892 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
• Identifier: 75-1976930-005 . This is a "TRICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 8314UB . This is a "BCBS BILLING NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: P01745932 . This is a "RR MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 280840408 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".