1275643355 NPI number — BOST, INC.

Table of content: (NPI 1275643355)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275643355 NPI number — BOST, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BOST, 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:
BOST C.A.R.E.S.
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:
1275643355
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/26/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 11495
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT SMITH
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72917-1495
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-478-5609
Provider Business Mailing Address Fax Number:
501-897-8339

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7701 S ZERO ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT SMITH
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72903-6644
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-784-1462
Provider Business Practice Location Address Fax Number:
479-784-1471
Provider Enumeration Date:
08/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
STOUT
Authorized Official First Name:
FRANCIS
Authorized Official Middle Name:
LYNNE
Authorized Official Title or Position:
BILLING SUPERVISOR
Authorized Official Telephone Number:
479-478-5609

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , with the licence number:  A1204035 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 253Z00000X , with the licence number: 1275643355 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 109365213 . This is a "LONG TERM CARE MEDICAID" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 105894724 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 125833767 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 119694213 . This is a "LONG TERM CARE MEDICAID" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 133310782 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 149998775 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 177755526 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 109364213 . This is a "LONG TERM CARE MEDICAID" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 132538786 . This is a "STATE MEDICAID" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 178138724 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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