1497854640 NPI number — ARKANSAS CENTER FOR SLEEP MEDICINE

Table of content: (NPI 1497854640)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497854640 NPI number — ARKANSAS CENTER FOR SLEEP MEDICINE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARKANSAS CENTER FOR SLEEP MEDICINE
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:
1497854640
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/18/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11219 FINANCIAL CENTRE PKWY STE 315
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:
72211-3895
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-661-9299
Provider Business Mailing Address Fax Number:
501-661-1991

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11219 FINANCIAL CENTRE PKWY STE 315
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:
72211-3895
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-661-9299
Provider Business Practice Location Address Fax Number:
501-661-1991
Provider Enumeration Date:
09/22/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WYLIE
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
E
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
501-303-0223

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , 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: 4023228001 . This is a "CIGNA PROVIDER #" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 470000063 . This is a "RAILROAD MEDICARE PROV #" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 5553617 . This is a "AETNA PROVIDER #" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 342001 . This is a "UNITED HEALTHCARE PROV #" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".