Provider Demographics
NPI:1437340601
Name:ROBERT R MCMINN
Entity Type:Organization
Organization Name:ROBERT R MCMINN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TAXONOMY X
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:R
Authorized Official - Last Name:MCMINN
Authorized Official - Suffix:II
Authorized Official - Credentials:CRNA
Authorized Official - Phone:936-546-3733
Mailing Address - Street 1:PO BOX 1043
Mailing Address - Street 2:
Mailing Address - City:CROCKETT
Mailing Address - State:TX
Mailing Address - Zip Code:75835-1043
Mailing Address - Country:US
Mailing Address - Phone:936-687-3242
Mailing Address - Fax:936-687-3242
Practice Address - Street 1:5300 NORTH ST
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-1370
Practice Address - Country:US
Practice Address - Phone:936-687-3242
Practice Address - Fax:936-687-3242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX511503261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
0005190215OtherAETNA
TX81214UOtherBCBS
0005190215OtherAETNA
TX81214UOtherBCBS