1235503459 NPI number — SOUTH LINCOLN HOSPITAL DISTRICT

Table of content: (NPI 1235503459)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235503459 NPI number — SOUTH LINCOLN HOSPITAL DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTH LINCOLN HOSPITAL DISTRICT
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:
ARROWHEAD FAMILY MEDICINE
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:
1235503459
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/03/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
195 FEATHER WAY STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EVANSTON
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
82930-9352
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-200-9200
Provider Business Mailing Address Fax Number:
307-200-4808

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
195 FEATHER WAY STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EVANSTON
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82930-9352
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-200-9200
Provider Business Practice Location Address Fax Number:
307-200-4808
Provider Enumeration Date:
11/26/2015

Additional Information

Authorized Official

Authorized Official Last Name:
SUNDBERG
Authorized Official First Name:
KARL
Authorized Official Middle Name:
E
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
307-877-4401

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  10314A , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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