1568471571 NPI number — ARKANSAS RURAL KARE, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568471571 NPI number — ARKANSAS RURAL KARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARKANSAS RURAL KARE, INC.
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:
6
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:
1568471571
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/25/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
310 TOWSON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT SMITH
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72901-3831
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-494-0009
Provider Business Mailing Address Fax Number:
479-494-0005

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
#4 HWY 71 NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNTAINBURG
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72946
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-369-2091
Provider Business Practice Location Address Fax Number:
479-369-4119
Provider Enumeration Date:
08/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KING
Authorized Official First Name:
WAYNE
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
479-494-0009

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 770245002 . This is a "ARKANSAS BREASTCARE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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