Provider Demographics
NPI:1922217157
Name:ROBINSON, PATSY
Entity Type:Individual
Prefix:
First Name:PATSY
Middle Name:
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 SOUTHRIDGE ESTATES
Mailing Address - Street 2:BOX 55
Mailing Address - City:BAXTER SPRINGS
Mailing Address - State:KS
Mailing Address - Zip Code:66713-2958
Mailing Address - Country:US
Mailing Address - Phone:620-856-2824
Mailing Address - Fax:620-856-2824
Practice Address - Street 1:1060 SOUTHRIDGE ESTATES
Practice Address - Street 2:
Practice Address - City:BAXTER SPRINGS
Practice Address - State:KS
Practice Address - Zip Code:66713-2958
Practice Address - Country:US
Practice Address - Phone:620-856-2824
Practice Address - Fax:620-856-2824
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS0562740001Medicare ID - Type UnspecifiedPROVIDER