1982737623 NPI number — ASCENT ACQUISITIONS CORP-CYPDC

Table of content: (NPI 1982737623)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982737623 NPI number — ASCENT ACQUISITIONS CORP-CYPDC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASCENT ACQUISITIONS CORP-CYPDC
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:
CHILD & YOUTH PEDIATRIC DAY CLINIC
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:
1982737623
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1201 S GEE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JONESBORO
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72401-3842
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-935-0260
Provider Business Mailing Address Fax Number:
870-935-0450

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1910 RECTOR RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARAGOULD
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72450-2004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-240-8500
Provider Business Practice Location Address Fax Number:
870-240-8505
Provider Enumeration Date:
03/13/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ALLGOOD
Authorized Official First Name:
HOLLY
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING SPECIALIST
Authorized Official Telephone Number:
870-935-0260

Provider Taxonomy Codes

  • Taxonomy code: 103TC2200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 251C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 5C363 . This is a "BCBS" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".