1164472478 NPI number — AR MEDICAL LLC

Table of content: (NPI 1164472478)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164472478 NPI number — AR MEDICAL LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AR MEDICAL LLC
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:
HINESVILLE FAMILY CARE CENTER
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:
1164472478
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
809 PEACHTREE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30434-1449
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
478-625-7597
Provider Business Mailing Address Fax Number:
478-625-8364

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
502 E GENERAL STEWART WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HINESVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31313-2629
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-368-4169
Provider Business Practice Location Address Fax Number:
912-368-5667
Provider Enumeration Date:
05/10/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PATKA
Authorized Official First Name:
FIROZ
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
478-625-7597

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  055918 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208000000X , with the licence number: 052399 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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