Basic Information
Provider Information | |||||||||
NPI: | 1013919075 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ROBBINS | ||||||||
FirstName: | SAMUEL | ||||||||
MiddleName: | GWIN | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: | JR. | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 7655 POPLAR AVE | ||||||||
Address2: | STE 350 | ||||||||
City: | GERMANTOWN | ||||||||
State: | TN | ||||||||
PostalCode: | 381383957 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9017612470 | ||||||||
FaxNumber: | 9017674898 | ||||||||
Practice Location | |||||||||
Address1: | 7655 POPLAR AVE | ||||||||
Address2: | STE 350 | ||||||||
City: | GERMANTOWN | ||||||||
State: | TN | ||||||||
PostalCode: | 381383957 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9017612470 | ||||||||
FaxNumber: | 9017674898 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/02/2005 | ||||||||
LastUpdateDate: | 06/10/2010 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208G00000X | MD8612 | TN | Y |   | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |   |
ID Information
ID | Type | State | Issuer | Description | 3906 | 01 | TN | TLC TENNCARE | OTHER | 201906401 | 05 | MO |   | MEDICAID | 153038 | 01 | TN | UNISON TENNCARE | OTHER | 3092503 | 01 | TN | BCBS OF TN | OTHER | 106803001 | 05 | AR |   | MEDICAID | 3191899 | 05 | TN |   | MEDICAID |