1205826575 NPI number — DAVID LEE WEBBER D.O. P.A.

Table of content: (NPI 1205826575)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205826575 NPI number — DAVID LEE WEBBER D.O. P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAVID LEE WEBBER D.O. P.A.
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:
WEBBER FAMILY PRACTICE
Provider Other Organization Name Type Code:
3
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:
1205826575
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/27/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
504 PECAN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HELENA
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72342-3214
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-338-9244
Provider Business Mailing Address Fax Number:
870-338-9278

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
504 PECAN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HELENA
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72342-3214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-338-9244
Provider Business Practice Location Address Fax Number:
870-338-9278
Provider Enumeration Date:
10/26/2005

Additional Information

Authorized Official

Authorized Official Last Name:
WEBBER
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
OWNER/PHYSICIAN
Authorized Official Telephone Number:
870-338-9244

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  R4242 , 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: 160924729 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 139831004 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com