1710225099 NPI number — MATERNITY CENTER OF NORTHWEST ARKANSAS LLC

Table of content: (NPI 1710225099)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710225099 NPI number — MATERNITY CENTER OF NORTHWEST ARKANSAS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MATERNITY CENTER OF NORTHWEST 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:
MATERNITY CENTER OF NORTHWEST ARKANSAS, LLC
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:
1710225099
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2000 S PROMENADE BLVD STE 202
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROGERS
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72758-8609
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-282-2737
Provider Business Mailing Address Fax Number:
877-671-7762

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5302 W VILLAGE PKWY STE 3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROGERS
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72758-8139
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-372-4560
Provider Business Practice Location Address Fax Number:
877-461-6743
Provider Enumeration Date:
01/22/2013

Additional Information

Authorized Official

Authorized Official Last Name:
SCALLY
Authorized Official First Name:
NICOLE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
MANAGING MEMBER
Authorized Official Telephone Number:
479-372-4560

Provider Taxonomy Codes

  • Taxonomy code: 261QB0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 367A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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