1558452995 NPI number — WOMEN'S CARE CENTER PA

Table of content: (NPI 1558452995)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558452995 NPI number — WOMEN'S CARE CENTER PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WOMEN'S CARE CENTER PA
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:
FRED E NEWTON 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:
1558452995
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/28/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 S UNIVERSITY AVE
Provider Second Line Business Mailing Address:
SUITE 712
Provider Business Mailing Address City Name:
LITTLE ROCK
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72205-5302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-280-9500
Provider Business Mailing Address Fax Number:
501-280-9359

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 S UNIVERSITY AVE
Provider Second Line Business Practice Location Address:
SUITE 712
Provider Business Practice Location Address City Name:
LITTLE ROCK
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72205-5302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-280-9500
Provider Business Practice Location Address Fax Number:
501-280-9359
Provider Enumeration Date:
09/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NEWTON
Authorized Official First Name:
FRED
Authorized Official Middle Name:
EARL
Authorized Official Title or Position:
OWNER/DR
Authorized Official Telephone Number:
501-280-9500

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  C-7131 , 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: 117482001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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