1962440891 NPI number — FINNEGANS INC

Table of content: (NPI 1962440891)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962440891 NPI number — FINNEGANS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FINNEGANS INC
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:
FINNEGAN HEALTH SERVICES
Provider Other Organization Name Type Code:
3
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:
1962440891
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/12/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1501 N UNIVERSITY AVE STE 400
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LITTLE ROCK
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72207-5233
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-663-6600
Provider Business Mailing Address Fax Number:
501-663-6668

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1501 N UNIVERSITY AVE STE 400
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LITTLE ROCK
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72207-5233
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-663-6600
Provider Business Practice Location Address Fax Number:
501-663-6668
Provider Enumeration Date:
06/03/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FOWLKES
Authorized Official First Name:
VICKI
Authorized Official Middle Name:
C
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
501-663-6600

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  MG00355 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BC3200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 233671773 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 115254716 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".