Provider Demographics
NPI:1134309859
Name:STUART TOBIN, P.S.C.
Entity Type:Organization
Organization Name:STUART TOBIN, P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STUART
Authorized Official - Middle Name:
Authorized Official - Last Name:TOBIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-623-4241
Mailing Address - Street 1:351 RADIO PARK DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-2454
Mailing Address - Country:US
Mailing Address - Phone:859-623-4241
Mailing Address - Fax:859-624-4414
Practice Address - Street 1:351 RADIO PARK DR
Practice Address - Street 2:SUITE 101
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-2454
Practice Address - Country:US
Practice Address - Phone:859-623-4241
Practice Address - Fax:859-624-4414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-09
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY18026174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64180268Medicaid
KYC69471Medicare UPIN
KY1004901Medicare PIN