1164695417 NPI number — J.MICHAEL CALHOUN MD PA

Table of content: (NPI 1164695417)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164695417 NPI number — J.MICHAEL CALHOUN MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
J.MICHAEL CALHOUN 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:
1164695417
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/27/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4020 RICHARDS RD
Provider Second Line Business Mailing Address:
SUITE I
Provider Business Mailing Address City Name:
NORTH LITTLE ROCK
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72117-2650
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-353-2123
Provider Business Mailing Address Fax Number:
501-771-4672

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4020 RICHARDS RD
Provider Second Line Business Practice Location Address:
SUITE I
Provider Business Practice Location Address City Name:
NORTH LITTLE ROCK
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72117-2650
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-353-2123
Provider Business Practice Location Address Fax Number:
501-771-4672
Provider Enumeration Date:
04/08/2008

Additional Information

Authorized Official

Authorized Official Last Name:
HENRY
Authorized Official First Name:
KAY
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
501-771-2000

Provider Taxonomy Codes

  • Taxonomy code: 207T00000X , with the licence number:  C6803 , 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: 52483 . This is a "AR BLUE CROSS" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 2848993 . This is a "CIGNA" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 310156900 . This is a "DEPT OF LABOR" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: P00145513 . This is a "RAIL ROAD MEDICARE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 5F041 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 1376531814 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 111633001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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