1205950326 NPI number — C. G. MELTON, M.D.,P.A.

Table of content: (NPI 1205950326)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205950326 NPI number — C. G. MELTON, M.D.,P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
C. G. MELTON, M.D.,P.A.
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:
OB-GYN 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:
1205950326
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2733
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BATESVILLE
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72503-2733
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-698-0300
Provider Business Mailing Address Fax Number:
870-698-2924

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
305 VIRGINIA DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BATESVILLE
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72501-7337
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-698-0300
Provider Business Practice Location Address Fax Number:
870-698-2924
Provider Enumeration Date:
03/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MELTON
Authorized Official First Name:
CLINTON
Authorized Official Middle Name:
G.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
870-698-0300

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  C-5164 , 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: 110292002 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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