1134155831 NPI number — ARKANSAS CHILDRENS HOSPITAL

Table of content: (NPI 1134155831)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134155831 NPI number — ARKANSAS CHILDRENS HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARKANSAS CHILDRENS HOSPITAL
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:
ARKANSAS CHILDRENS HOSPITAL PHARMACY
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:
1134155831
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/05/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 959794
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63195-9794
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-364-2526
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 CHILDRENS WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LITTLE ROCK
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72202-3500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-364-1272
Provider Business Practice Location Address Fax Number:
501-364-4225
Provider Enumeration Date:
06/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PHILLIPS
Authorized Official First Name:
SHERYL
Authorized Official Middle Name:
Authorized Official Title or Position:
SR. BILLING MANAGER
Authorized Official Telephone Number:
501-364-2526

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: AR08143 , 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: 00097767 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 011381209 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100514407 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 580038 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1993615 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100817680C , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1742104 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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