1033207675 NPI number — ADVANCE CARE HOSPITAL

Table of content: (NPI 1033207675)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033207675 NPI number — ADVANCE CARE HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCE CARE HOSPITAL
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:
6
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:
1033207675
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7301 ROGERS AVE
Provider Second Line Business Mailing Address:
4TH FLOOR
Provider Business Mailing Address City Name:
FORT SMITH
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72903-4100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-314-4900
Provider Business Mailing Address Fax Number:
479-314-4980

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7301 ROGERS AVE
Provider Second Line Business Practice Location Address:
4TH FLOOR
Provider Business Practice Location Address City Name:
FORT SMITH
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72903-4100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-314-4900
Provider Business Practice Location Address Fax Number:
479-314-4980
Provider Enumeration Date:
10/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CARRIER
Authorized Official First Name:
PATRICK
Authorized Official Middle Name:
B.
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
713-277-2771

Provider Taxonomy Codes

  • Taxonomy code: 282E00000X , with the licence number:  4139 , 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: 3441098 . This is a "AETNA PVN" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 186857105 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 12008 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 7697536 . This is a "AETNA PIN" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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