1972807360 NPI number — FEET PLUS OF ARKANSAS INC

Table of content: (NPI 1972807360)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972807360 NPI number — FEET PLUS OF ARKANSAS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FEET PLUS OF ARKANSAS 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:
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:
1972807360
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/29/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2852 BELLA VISTA WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELLA VISTA
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72714-3708
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-268-3477
Provider Business Mailing Address Fax Number:
479-268-3478

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2852 BELLA VISTA WAY STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELLA VISTA
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72714-3708
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-268-3477
Provider Business Practice Location Address Fax Number:
479-268-3477
Provider Enumeration Date:
12/29/2010

Additional Information

Authorized Official

Authorized Official Last Name:
SANCHEZ
Authorized Official First Name:
BERT
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
479-268-3477

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  1532 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 182546002 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 181553002 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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