1467833152 NPI number — WILLIAM BOHRMAN CRNA

Table of content: WILLIAM BOHRMAN CRNA (NPI 1467833152)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467833152 NPI number — WILLIAM BOHRMAN CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOHRMAN
Provider First Name:
WILLIAM
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
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:
1467833152
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/18/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8099
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JONESBORO
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72403-8099
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-932-4211
Provider Business Mailing Address Fax Number:
870-931-9141

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
225 E JACKSON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JONESBORO
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72401-3119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-207-4100
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/18/2015

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: 367500000X , with the licence number:  C003094 , 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)