1033394457 NPI number — ARKANSAS PLASTIC SURGERY, P.A.

Table of content: KHURSHIDA ACHILOVA CM, LM (NPI 1679179477)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033394457 NPI number — ARKANSAS PLASTIC SURGERY, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARKANSAS PLASTIC SURGERY, P.A.
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:
1033394457
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/03/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9500 KANIS RD
Provider Second Line Business Mailing Address:
SUITE 502
Provider Business Mailing Address City Name:
LITTLE ROCK
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72205-6324
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-219-8388
Provider Business Mailing Address Fax Number:
501-217-2520

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9500 KANIS RD
Provider Second Line Business Practice Location Address:
SUITE 502
Provider Business Practice Location Address City Name:
LITTLE ROCK
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72205-6324
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-219-8388
Provider Business Practice Location Address Fax Number:
501-217-2520
Provider Enumeration Date:
01/03/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BURNS
Authorized Official First Name:
RUDY
Authorized Official Middle Name:
H
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
501-219-8388

Provider Taxonomy Codes

  • Taxonomy code: 208200000X , 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)





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