1881319507 NPI number — CITY OF RUSSELLVILLE OFFICE OF CITY

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 1881319507 NPI number — CITY OF RUSSELLVILLE OFFICE OF CITY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF RUSSELLVILLE OFFICE OF CITY
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:
1881319507
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/17/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
107 N EL PASO AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RUSSELLVILLE
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72801-3719
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-968-2332
Provider Business Mailing Address Fax Number:
479-967-2087

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
107 N EL PASO AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RUSSELLVILLE
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72801-3719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-968-2332
Provider Business Practice Location Address Fax Number:
479-967-2087
Provider Enumeration Date:
10/05/2022

Additional Information

Authorized Official

Authorized Official Last Name:
PERRY
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
HAROLD
Authorized Official Title or Position:
DIVISION CHIEF OF EMS
Authorized Official Telephone Number:
479-968-2332

Provider Taxonomy Codes

  • Taxonomy code: 341600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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