Provider Demographics
NPI:1922264225
Name:BOB ROBERTSON, MNSC,RN,CS,PC
Entity Type:Organization
Organization Name:BOB ROBERTSON, MNSC,RN,CS,PC
Other - Org Name:BOB ROBERTSON, MNSC, RN, CS, PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL NURSE SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:R
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:MNSC
Authorized Official - Phone:903-782-9500
Mailing Address - Street 1:PO BOX 6369
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75461-6245
Mailing Address - Country:US
Mailing Address - Phone:903-782-9500
Mailing Address - Fax:903-782-9550
Practice Address - Street 1:3605 N.E. LOOP 286
Practice Address - Street 2:SUITE 2000
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-5085
Practice Address - Country:US
Practice Address - Phone:903-782-9500
Practice Address - Fax:903-782-9550
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOB ROBERTSON, MNSC,RN,CS,PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-08-06
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX569790364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, AdultGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0042RSOtherBLUE CROSS BLUE SHIELD
TX196224301Medicaid
TX00Z529Medicare PIN