1467743062 NPI number — MEDICAL BILLING OF ARKANSAS, LLC

Table of content: (NPI 1467743062)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467743062 NPI number — MEDICAL BILLING OF ARKANSAS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDICAL BILLING OF ARKANSAS, LLC
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:
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NPI Number Information

NPI Number:
1467743062
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/24/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 13267
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAUMELLE
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72113-0267
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-791-0198
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
209 S PORTLAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RUSSELLVILLE
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72801-2339
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-968-8279
Provider Business Practice Location Address Fax Number:
479-968-4331
Provider Enumeration Date:
04/29/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
THOMASON
Authorized Official First Name:
RODNEY
Authorized Official Middle Name:
Authorized Official Title or Position:
MEMBER/MANAGER
Authorized Official Telephone Number:
479-968-8279

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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