1255339271 NPI number — UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES

Table of content: (NPI 1255339271)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255339271 NPI number — UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES
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:
AHEC-SW ALL FOR KIDS PEDIATRIC CLINIC
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:
1255339271
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 E 6TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TEXARKANA
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
71854-5207
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-779-6000
Provider Business Mailing Address Fax Number:
870-779-6119

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 E 6TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TEXARKANA
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
71854-5207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-779-6004
Provider Business Practice Location Address Fax Number:
870-779-6100
Provider Enumeration Date:
07/13/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MCDONALD
Authorized Official First Name:
JUDY
Authorized Official Middle Name:
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
870-779-6067

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , 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: 152802769 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 092113205 . This is a "NO DISCRIPTION" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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