1326125063 NPI number — SUMMIT MEDICAL SUPPLY INC

Table of content: (NPI 1326125063)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326125063 NPI number — SUMMIT MEDICAL SUPPLY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUMMIT MEDICAL SUPPLY INC
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:
1326125063
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/13/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2486
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CONWAY
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72033-2486
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-327-5426
Provider Business Mailing Address Fax Number:
501-327-5881

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
170 COMMERCE RD
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
CONWAY
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72032-7112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-327-5426
Provider Business Practice Location Address Fax Number:
501-327-5881
Provider Enumeration Date:
11/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HENRY
Authorized Official First Name:
BRYAN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
501-327-5426

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  MG00806 , 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: 9061334 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 129219 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: DM1270 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 240067000 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 432970700 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 49980 . This is a "AR BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 626353304 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1034061 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com