1093137507 NPI number — ARKANSAS RHEUMATOLOGY CENTER, PLLC

Table of content: (NPI 1093137507)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093137507 NPI number — ARKANSAS RHEUMATOLOGY CENTER, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARKANSAS RHEUMATOLOGY CENTER, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1093137507
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/17/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 55630
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:
72215-5630
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-217-9382
Provider Business Mailing Address Fax Number:
501-217-1692

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9101 KANIS RD
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
LITTLE ROCK
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72205-6456
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-217-9382
Provider Business Practice Location Address Fax Number:
501-217-1692
Provider Enumeration Date:
01/17/2014

Additional Information

Authorized Official

Authorized Official Last Name:
YORK
Authorized Official First Name:
MARION
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
501-227-7688

Provider Taxonomy Codes

  • Taxonomy code: 207RR0500X , with the licence number:  BL150264 , 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: BL150264 . This is a "BUSINESS LICENSE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com