1871749200 NPI number — LITTLE AND ASSOCIATES LLC

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 1871749200 NPI number — LITTLE AND ASSOCIATES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LITTLE AND ASSOCIATES 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:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871749200
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/26/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8830 CENTRE ST
Provider Second Line Business Mailing Address:
SUITE 5
Provider Business Mailing Address City Name:
SOUTHAVEN
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
38671-2609
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-510-3986
Provider Business Mailing Address Fax Number:
662-510-3988

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8830 CENTRE ST
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
SOUTHAVEN
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38671-2609
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-510-3986
Provider Business Practice Location Address Fax Number:
662-510-3988
Provider Enumeration Date:
08/18/2008

Additional Information

Authorized Official

Authorized Official Last Name:
DAY
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
HOWARD
Authorized Official Title or Position:
GENERAL MANAGER
Authorized Official Telephone Number:
662-510-3986

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  31-465 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103TC0700X , with the licence number: P0000001384 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 680000164 . This is a "MEDICARE PTEN" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 510G700396 . This is a "MEDICARE - LA PTAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 512I680050 . This is a "MEDICARE - LA MLH PTAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00114932 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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