1518977669 NPI number — STATE OF ARKANSAS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518977669 NPI number — STATE OF ARKANSAS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STATE OF 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:
SCOTT COUNTY HEALTH UNIT
Provider Other Organization Name Type Code:
3
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:
1518977669
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5800 WEST 10TH STREET
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
LITTLE ROCK
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72204-1764
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-661-2614
Provider Business Mailing Address Fax Number:
501-661-2975

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
487 WEST 6TH STREET
Provider Second Line Business Practice Location Address:
SCOTT COUNTY HEALTH UNIT
Provider Business Practice Location Address City Name:
WALDRON
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72958-4630
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-637-2165
Provider Business Practice Location Address Fax Number:
479-637-2394
Provider Enumeration Date:
08/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
EVANS
Authorized Official First Name:
MARILYN
Authorized Official Middle Name:
Authorized Official Title or Position:
HOME HEALTH ADMINISTRATOR
Authorized Official Telephone Number:
501-661-2540

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  AR4021 , 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: 104312514 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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