1417940255 NPI number — MR. MICHAEL G SANGSTER MD

Table of content: MR. MICHAEL G SANGSTER MD (NPI 1417940255)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417940255 NPI number — MR. MICHAEL G SANGSTER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANGSTER
Provider First Name:
MICHAEL
Provider Middle Name:
G
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1417940255
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/15/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2524 CRESTWOOD RD
Provider Second Line Business Mailing Address:
SUITE 3
Provider Business Mailing Address City Name:
NORTH LITTLE ROCK
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72116-7623
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-791-7546
Provider Business Mailing Address Fax Number:
501-753-1992

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2524 CRESTWOOD RD
Provider Second Line Business Practice Location Address:
SUITE 3
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:
72116-7623
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-791-7546
Provider Business Practice Location Address Fax Number:
501-753-1992
Provider Enumeration Date:
08/26/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  C8303 , 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: 132088002 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 070009090 . This is a "RR MC" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 5594317 . This is a "AETNA" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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