1265567168 NPI number — EASTER SEALS ARKANSAS

Table of content: (NPI 1265567168)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265567168 NPI number — EASTER SEALS ARKANSAS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EASTER SEALS ARKANSAS
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:
ARKANSAS EASTER SEAL SOCIETY
Provider Other Organization Name Type Code:
5
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:
1265567168
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/01/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3920 WOODLAND HEIGHTS RD
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:
72212-2495
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-227-3662
Provider Business Mailing Address Fax Number:
501-227-3658

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3920 WOODLAND HEIGHTS RD
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:
72212-2495
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-227-3662
Provider Business Practice Location Address Fax Number:
501-227-3658
Provider Enumeration Date:
02/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
STEPHANIE
Authorized Official Middle Name:
GAYLE
Authorized Official Title or Position:
VICE PRESIDENT ADMIN & FINANCE
Authorized Official Telephone Number:
501-227-3662

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 116088742 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5B959 . This is a "AR BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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