1376816850 NPI number — CANZONERI MFM, PLLC

Table of content: (NPI 1376816850)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376816850 NPI number — CANZONERI MFM, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CANZONERI MFM, PLLC
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:
MATERNAL-FETAL MEDICINE CENTER OF NORTHWEST ARKANSAS
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:
1376816850
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/15/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5501 WILLOW CREEK DR
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
SPRINGDALE
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72762-8704
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-443-4500
Provider Business Mailing Address Fax Number:
479-443-4502

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5501 WILLOW CREEK DR
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
SPRINGDALE
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72762-8704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-443-4500
Provider Business Practice Location Address Fax Number:
479-443-4502
Provider Enumeration Date:
02/15/2012

Additional Information

Authorized Official

Authorized Official Last Name:
CANZONERI
Authorized Official First Name:
BERNARD
Authorized Official Middle Name:
J
Authorized Official Title or Position:
M.D./ OWNER
Authorized Official Telephone Number:
479-443-4500

Provider Taxonomy Codes

  • Taxonomy code: 207VM0101X , with the licence number:  E-7297 , 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)





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