Provider Demographics
NPI:1700823176
Name:ROBERT L. ROBBINS, D.O., LLC
Entity Type:Organization
Organization Name:ROBERT L. ROBBINS, D.O., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROBBINS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:573-683-3739
Mailing Address - Street 1:400 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:MO
Mailing Address - Zip Code:63834-1644
Mailing Address - Country:US
Mailing Address - Phone:573-683-3739
Mailing Address - Fax:573-683-4956
Practice Address - Street 1:400 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:MO
Practice Address - Zip Code:63834-1644
Practice Address - Country:US
Practice Address - Phone:573-683-3739
Practice Address - Fax:573-683-4956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO31640207Q00000X
261QR1300X
MO116998363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO268927Medicare Oscar/Certification
MOD41670Medicare UPIN