1174585061 NPI number — NEUROLOGY ASSOCIATES OF NORTHEAST ARKANSAS PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174585061 NPI number — NEUROLOGY ASSOCIATES OF NORTHEAST ARKANSAS PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEUROLOGY ASSOCIATES OF NORTHEAST ARKANSAS 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:
1174585061
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/06/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1107 E MATTHEWS AVE
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
JONESBORO
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72401-4315
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-931-4442
Provider Business Mailing Address Fax Number:
870-802-0205

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1107 E MATTHEWS AVE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
JONESBORO
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72401-4315
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-931-4442
Provider Business Practice Location Address Fax Number:
870-802-0205
Provider Enumeration Date:
04/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SOUTH
Authorized Official First Name:
RON
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
870-931-4442

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 143512002 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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