1013103415 NPI number — CYNTHIA DIANNE ARNOLD-SPRUILL NP

Table of content: CYNTHIA DIANNE ARNOLD-SPRUILL NP (NPI 1013103415)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013103415 NPI number — CYNTHIA DIANNE ARNOLD-SPRUILL NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ARNOLD-SPRUILL
Provider First Name:
CYNTHIA
Provider Middle Name:
DIANNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ARNOLD
Provider Other First Name:
CYNTHIA
Provider Other Middle Name:
DIANNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
NP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1013103415
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/04/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 247
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAUREL
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39441-0247
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-399-6167
Provider Business Mailing Address Fax Number:
601-399-6281

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
424 S 13TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAUREL
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39440-4345
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-649-5990
Provider Business Practice Location Address Fax Number:
601-425-7510
Provider Enumeration Date:
09/19/2007

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: 363LF0000X , with the licence number:  R623113 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2831404 . This is a "UHC" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: P00691502 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 04984364 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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