Provider Demographics
NPI:1275545501
Name:ROBINSON, HUEY G (LPN)
Entity Type:Individual
Prefix:MR
First Name:HUEY
Middle Name:G
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:HUEY'S
Other - Middle Name:HOME
Other - Last Name:MEDICAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:828 PIONEER ST
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-2513
Mailing Address - Country:US
Mailing Address - Phone:217-356-4839
Mailing Address - Fax:217-356-5190
Practice Address - Street 1:828 PIONEER ST
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-2513
Practice Address - Country:US
Practice Address - Phone:217-356-4839
Practice Address - Fax:217-356-5190
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL201837649001Medicaid
IL201837649001Medicaid