1205936598 NPI number — CENTRAL ARKANSAS VETRANS HEALTHCARE SERVICE

Table of content: DR. CARLOS ADOLFO ORTIZ JR. MD (NPI 1902972979)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205936598 NPI number — CENTRAL ARKANSAS VETRANS HEALTHCARE SERVICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL ARKANSAS VETRANS HEALTHCARE SERVICE
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:
1205936598
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3016 MOSSY CREEK DR
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:
72211-4455
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-225-6166
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4300 W 7TH ST
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:
72205-5446
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-257-6333
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KEMP
Authorized Official First Name:
WILLAIM
Authorized Official Middle Name:
F
Authorized Official Title or Position:
PHARMACY SUPV
Authorized Official Telephone Number:
501-257-6333

Provider Taxonomy Codes

  • Taxonomy code: 282NC0060X , with the licence number:  6066 , 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)





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