1144224635 NPI number — ANDRE J. NOLEWAJKA, MD, PA

Table of content: (NPI 1144224635)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144224635 NPI number — ANDRE J. NOLEWAJKA, MD, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANDRE J. NOLEWAJKA, MD, PA
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:
1144224635
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/12/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 10570
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT SMITH
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72917-0570
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-452-7324
Provider Business Mailing Address Fax Number:
479-452-6793

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2713 S 74TH ST
Provider Second Line Business Practice Location Address:
STE 401
Provider Business Practice Location Address City Name:
FORT SMITH
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72903-5173
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-452-7324
Provider Business Practice Location Address Fax Number:
479-452-6793
Provider Enumeration Date:
06/13/2005

Additional Information

Authorized Official

Authorized Official Last Name:
NOLEWAJKA
Authorized Official First Name:
ANDRE
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
479-452-7324

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  MC-1345 , 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)





Copyright © 2007-2024 www.npivalidator.com