1194615732 NPI number — UNION RESCUE MISSION INCORPORATED

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 1194615732 NPI number — UNION RESCUE MISSION INCORPORATED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNION RESCUE MISSION INCORPORATED
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:
1194615732
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/07/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 164057
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LITTLE ROCK
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72216-4057
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-370-0808
Provider Business Mailing Address Fax Number:
501-353-0714

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3001 SPRINGER BLVD
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:
72206-3313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-370-0808
Provider Business Practice Location Address Fax Number:
501-370-0808
Provider Enumeration Date:
07/07/2025

Additional Information

Authorized Official

Authorized Official Last Name:
MEDLOCK
Authorized Official First Name:
KEITH
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
501-370-0808

Provider Taxonomy Codes

  • Taxonomy code: 261QR0405X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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