Provider Demographics
NPI:1306811880
Name:ROBERT R YASUI
Entity type:Organization
Organization Name:ROBERT R YASUI
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:YASUI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-695-5466
Mailing Address - Street 1:PO BOX 8187
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:TN
Mailing Address - Zip Code:37352-8187
Mailing Address - Country:US
Mailing Address - Phone:931-759-4197
Mailing Address - Fax:
Practice Address - Street 1:40 LYNCHBURG HWY
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:TN
Practice Address - Zip Code:37352-7449
Practice Address - Country:US
Practice Address - Phone:931-759-4197
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-20
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0443866261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0443866Medicaid
TN443866Medicare ID - Type Unspecified