1093801342 NPI number — LEE W. HODGE D.C. P.A.

Table of content: (NPI 1093801342)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093801342 NPI number — LEE W. HODGE D.C. P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEE W. HODGE D.C. 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:
1093801342
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:
PO BOX 1600
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CONWAY
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72033-1600
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-329-2774
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1214 HOGAN LN
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
CONWAY
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72034-8002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-329-2774
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HODGE
Authorized Official First Name:
LEE
Authorized Official Middle Name:
W
Authorized Official Title or Position:
CHIROPRACTOR
Authorized Official Telephone Number:
501-329-2774

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  1439 , 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)

  • Identifier: 44-20060 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 5T646 . This is a "BLUE ADVANTAGE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: P00228479 . This is a "MEDICARE (RAILROAD)" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 5T646 . This is a "BLUE CROSS BLUE SHEILD" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 18895000040 . This is a "QCA" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 5T646 . This is a "HEALTH ADVANTAGE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: S02725 . This is a "NOVA SYSTEMS" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 7211190 . This is a "AETNA" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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