1912945528 NPI number — DR. ROBERT MAC COWHERD MD/PHD

Table of content: DR. ROBERT MAC COWHERD MD/PHD (NPI 1912945528)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912945528 NPI number — DR. ROBERT MAC COWHERD MD/PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COWHERD
Provider First Name:
ROBERT
Provider Middle Name:
MAC
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD/PHD
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:
1912945528
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/24/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1678
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HEBER SPRINGS
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72543-1678
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-362-0500
Provider Business Mailing Address Fax Number:
501-362-0501

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 BAPTIST HEALTH DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HEBER SPRINGS
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72543-8765
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-362-0500
Provider Business Practice Location Address Fax Number:
501-362-0501
Provider Enumeration Date:
06/04/2006

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: 207Q00000X , with the licence number:  E3104 , 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: 5M087 . This is a "BCBS NUMBER" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 146104001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7204399 . This is a "AETNA NUMBER" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 9076374002 . This is a "CIGNA NUMBER" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 731667341-72543-A003 . This is a "TRICARE NUMBER" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 03110011900 . This is a "QUALCHOICE NUMBER" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: P00091289 . This is a "RAILROAD MEDICARE NUMBER" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com