1962440701 NPI number — DR. MICHAEL J BUTLER M.D.

Table of content: DR. MICHAEL J BUTLER M.D. (NPI 1962440701)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962440701 NPI number — DR. MICHAEL J BUTLER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUTLER
Provider First Name:
MICHAEL
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1962440701
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/25/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
603-2 N PROGRESS AVE STE 400
Provider Second Line Business Mailing Address:
SILOAM SPRINGS CARDIOLOGY
Provider Business Mailing Address City Name:
SILOAM SPRINGS
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72761-4401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-215-3060
Provider Business Mailing Address Fax Number:
479-549-4044

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
603-2 N PROGRESS AVE STE 400
Provider Second Line Business Practice Location Address:
SILOAM SPRINGS CARDIOLOGY
Provider Business Practice Location Address City Name:
SILOAM SPRINGS
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72761-4401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-215-3060
Provider Business Practice Location Address Fax Number:
479-549-4044
Provider Enumeration Date:
06/03/2006

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: 207RC0000X , with the licence number:  25MA05045100 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X , with the licence number: E-7929 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RC0000X , with the licence number: 30125 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X , with the licence number: 9701266 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X , with the licence number: 0101050127 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X , with the licence number: MD044769E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 60022220 . This is a "HORIZON NJ HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 001007591 . This is a "AMERICHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0013846 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3K5951 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00390944 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 42419 . This is a "UNIVERSITY HEALTHPLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1168522 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: P3722693 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2341853 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 955491 . This is a "PA BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".