1073509956 NPI number — NEESA J MCCOLLUM FLAXMAN M.D.

Table of content: NEESA J MCCOLLUM FLAXMAN M.D. (NPI 1073509956)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073509956 NPI number — NEESA J MCCOLLUM FLAXMAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCOLLUM FLAXMAN
Provider First Name:
NEESA
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073509956
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/08/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8201 CANTRELL RD STE 250
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LITTLE ROCK
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72227-2503
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-466-7246
Provider Business Mailing Address Fax Number:
501-456-7246

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8201 CANTRELL RD STE 250
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LITTLE ROCK
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72227-2503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-466-7246
Provider Business Practice Location Address Fax Number:
501-456-7246
Provider Enumeration Date:
09/26/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207LP2900X , with the licence number:  E-2798 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207L00000X , with the licence number: E-2798 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 171973300 . This is a "US DEPT. OF LABOR OWCP" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 5M491 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: P00001818 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: S03153 . This is a "NOVASYS" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 03080013000 . This is a "QUAL CHOICE (LRPM)" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 71033532430 . This is a "QUAL CHOICE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 149510001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 770258801 . This is a "ARKANSAS BREASTCARE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: P00001823 . This is a "RAILROAD MEDICARE (LRPM)" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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