1316250251 NPI number — LITTLE ROCK PHYSICAL MEDICINE & REHABILITATION

Table of content: (NPI 1316250251)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316250251 NPI number — LITTLE ROCK PHYSICAL MEDICINE & REHABILITATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LITTLE ROCK PHYSICAL MEDICINE & REHABILITATION
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:
THOMAS M. WARD, MD
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:
1316250251
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 23804
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LITTLE ROCK
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72221-3804
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-223-9775
Provider Business Mailing Address Fax Number:
501-228-9341

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3127 W 2ND CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RUSSELLVILLE
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72801-4504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-692-3060
Provider Business Practice Location Address Fax Number:
501-228-9341
Provider Enumeration Date:
07/21/2010

Additional Information

Authorized Official

Authorized Official Last Name:
WARD
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
501-223-9775

Provider Taxonomy Codes

  • Taxonomy code: 2081P2900X , with the licence number:  N7806 , 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)





Copyright © 2007-2024 www.npivalidator.com