1316905920 NPI number — LITTLE ROCK VAMC

Table of content: MRS. BILLIE JEAN FAUST LPC (NPI 1851437586)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316905920 NPI number — LITTLE ROCK VAMC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LITTLE ROCK VAMC
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:
6
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:
1316905920
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/09/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 94499
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEVELAND
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44101
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-355-3451
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2200 FORT ROOTS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH LITTLE ROCK
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72114-1709
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-257-2900
Provider Business Practice Location Address Fax Number:
501-257-2702
Provider Enumeration Date:
05/03/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
POTTER
Authorized Official First Name:
ERIN
Authorized Official Middle Name:
Authorized Official Title or Position:
NPI TEAM MEMBER
Authorized Official Telephone Number:
202-382-2579

Provider Taxonomy Codes

  • Taxonomy code: 332100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0420339 . This is a "NCPDP#" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".