1932164084 NPI number — LINDA G CABINE A.N.P.

Table of content: LINDA G CABINE A.N.P. (NPI 1932164084)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932164084 NPI number — LINDA G CABINE A.N.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CABINE
Provider First Name:
LINDA
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
A.N.P.
Provider Gender Code:
F

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:
1932164084
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/17/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4747 DUSTY LAKE DR
Provider Second Line Business Mailing Address:
STE G1
Provider Business Mailing Address City Name:
PINE BLUFF
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
71603-9056
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-536-6600
Provider Business Mailing Address Fax Number:
870-850-7959

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
209 NORTH BLAKE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PINE BLUFF
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-536-6600
Provider Business Practice Location Address Fax Number:
870-850-7959
Provider Enumeration Date:
04/20/2006

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:  A01480 , 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: 5W332 . This is a "MEDICARE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: P25891 . This is a "UPIN" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 157705758 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".