1669747762 NPI number — MR. MICHAEL CHARLES SEAMON APN

Table of content: MR. MICHAEL CHARLES SEAMON APN (NPI 1669747762)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669747762 NPI number — MR. MICHAEL CHARLES SEAMON APN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEAMON
Provider First Name:
MICHAEL
Provider Middle Name:
CHARLES
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
APN
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:
1669747762
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9501 BAPTIST HEALTH DR
Provider Second Line Business Mailing Address:
SUITE 600
Provider Business Mailing Address City Name:
LITTLE ROCK
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72205-6225
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-227-7596
Provider Business Mailing Address Fax Number:
501-978-1959

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9501 BAPTIST HEALTH DR
Provider Second Line Business Practice Location Address:
SUITE 600
Provider Business Practice Location Address City Name:
LITTLE ROCK
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72205-6225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-227-7596
Provider Business Practice Location Address Fax Number:
501-978-1959
Provider Enumeration Date:
03/21/2012

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: 363LF0000X , with the licence number:  A03677 , 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)





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