1265533350 NPI number — WOMANS PAVILION

Table of content: (NPI 1265533350)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265533350 NPI number — WOMANS PAVILION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WOMANS PAVILION
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:
MEDICAL OFFICE
Provider Other Organization Name Type Code:
4
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:
1265533350
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/28/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 ST VINCENT CR
Provider Second Line Business Mailing Address:
#440
Provider Business Mailing Address City Name:
LITTLE ROCK
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72205-5492
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-666-4294
Provider Business Mailing Address Fax Number:
501-666-8538

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 ST VINCENT CR
Provider Second Line Business Practice Location Address:
#440
Provider Business Practice Location Address City Name:
LITTLE ROCK
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72205-5492
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-666-4294
Provider Business Practice Location Address Fax Number:
501-666-8538
Provider Enumeration Date:
09/25/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MCFARLAND
Authorized Official First Name:
CORTEZ
Authorized Official Middle Name:
EVON
Authorized Official Title or Position:
PHYSICIAN OWNER
Authorized Official Telephone Number:
501-666-4294

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , 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)