1982721882 NPI number — WILLIAM H. FREEMAN, M.D., P.A.

Table of content: (NPI 1982721882)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982721882 NPI number — WILLIAM H. FREEMAN, M.D., P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILLIAM H. FREEMAN, M.D., P.A.
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:
1982721882
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/31/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 CLUB LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CONWAY
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72034-3624
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-327-0110
Provider Business Mailing Address Fax Number:
501-327-0141

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 CLUB LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CONWAY
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72034-3624
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-327-0110
Provider Business Practice Location Address Fax Number:
501-327-0141
Provider Enumeration Date:
03/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FREEMAN
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
H.
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
501-327-0110

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  C6022 , 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: 131627002 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 04D0957619 . This is a "CLIA NUMBER" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: C6022 . This is a "LICENSE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 1982721882 . This is a "GROUP NPI" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 110995001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com