1083580856 NPI number — MOMENTUM HEALTH INDUSTRIES INC

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 1083580856 NPI number — MOMENTUM HEALTH INDUSTRIES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOMENTUM HEALTH INDUSTRIES INC
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:
1083580856
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/16/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
555 N 13TH ST STE A-11
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:
72756-3431
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-755-2777
Provider Business Mailing Address Fax Number:
479-259-1869

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
555 N 13TH ST STE A-11
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:
72756-3431
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-755-2777
Provider Business Practice Location Address Fax Number:
479-259-1869
Provider Enumeration Date:
10/16/2025

Additional Information

Authorized Official

Authorized Official Last Name:
CAMPBELL
Authorized Official First Name:
JASPER
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT-CEO
Authorized Official Telephone Number:
479-755-2777

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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