1558515775 NPI number — SOUTH ARKANSAS REGIONAL HEALTH CENTER CROSSROADS

Table of content: DR. REBECCA PARAS ONG MD (NPI 1700198439)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558515775 NPI number — SOUTH ARKANSAS REGIONAL HEALTH CENTER CROSSROADS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTH ARKANSAS REGIONAL HEALTH CENTER CROSSROADS
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:
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:
1558515775
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
715 N COLLEGE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EL DORADO
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
71730-4403
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-862-7921
Provider Business Mailing Address Fax Number:
870-864-2490

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
710 W GROVE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EL DORADO
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
71730-4416
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-864-2471
Provider Business Practice Location Address Fax Number:
870-864-2490
Provider Enumeration Date:
11/14/2008

Additional Information

Authorized Official

Authorized Official Last Name:
PEEL
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
C
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
870-862-7921

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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