1225037401 NPI number — NATIONAL IV, INC.

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 1225037401 NPI number — NATIONAL IV, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NATIONAL IV, INC.
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:
6
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:
1225037401
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 676499
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75267-6499
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-537-2323
Provider Business Mailing Address Fax Number:
501-671-6801

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5700 S ZERO ST
Provider Second Line Business Practice Location Address:
STE. 2
Provider Business Practice Location Address City Name:
FORT SMITH
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72903-6505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-649-6464
Provider Business Practice Location Address Fax Number:
479-649-6565
Provider Enumeration Date:
07/19/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GOUY
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
SR. VICE PRESDIENT
Authorized Official Telephone Number:
615-221-8191

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  0420116 , 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)