1114940996 NPI number — DR. SCOTT M SCHLESINGER MD

Table of content: DR. SCOTT M SCHLESINGER MD (NPI 1114940996)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114940996 NPI number — DR. SCOTT M SCHLESINGER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHLESINGER
Provider First Name:
SCOTT
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1114940996
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/19/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 53985
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAFAYETTE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70505-3985
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-661-0077
Provider Business Mailing Address Fax Number:
501-664-2749

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5800 W 10TH ST
Provider Second Line Business Practice Location Address:
ST 205
Provider Business Practice Location Address City Name:
LITTLE ROCK
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-661-0077
Provider Business Practice Location Address Fax Number:
501-664-2749
Provider Enumeration Date:
07/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  C7144 , 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: C7144 . This is a "AR LICENSE NUMBER" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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