1275941064 NPI number — BRIAN K LINN, MD

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 1275941064 NPI number — BRIAN K LINN, MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRIAN K LINN, MD
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:
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:
1275941064
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/09/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2779
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARRISON
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72602-2779
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-741-8289
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
224 W ERIE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARRISON
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72601-3539
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-741-8289
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/24/2014

Additional Information

Authorized Official

Authorized Official Last Name:
LINN
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
KEITH
Authorized Official Title or Position:
PHYSICIAN OWNER
Authorized Official Telephone Number:
870-741-8289

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  E-5068 , 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: 5H450 . This is a "MEDICARE PTAN WHILE AT VILLAGE PARK (NO LONGER THERE)" identifier . This identifiers is of the category "OTHER".
  • Identifier: 177387001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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