1427196807 NPI number — WILLIAM J BULKLEY M D P A

Table of content: (NPI 1427196807)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427196807 NPI number — WILLIAM J BULKLEY M D P A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILLIAM J BULKLEY M D 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:
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:
1427196807
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/30/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 579
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PARAGOULD
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72451-0579
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-240-8020
Provider Business Mailing Address Fax Number:
870-240-8028

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 W KINGSHIGHWAY
Provider Second Line Business Practice Location Address:
STE # 3
Provider Business Practice Location Address City Name:
PARAGOULD
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72450-4141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-240-8020
Provider Business Practice Location Address Fax Number:
870-240-8028
Provider Enumeration Date:
02/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BULKLEY
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
JENNISON
Authorized Official Title or Position:
PHYSICAN - OWNER
Authorized Official Telephone Number:
870-240-8020

Provider Taxonomy Codes

  • Taxonomy code: 207KA0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207YS0012X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207YX0602X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207YX0905X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2082S0099X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0122X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 231H00000X , with the licence number: A417 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 131753002 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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