1043413909 NPI number — DR. JAMIE C IRWIN DO

Table of content: DR. JAMIE C IRWIN DO (NPI 1043413909)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043413909 NPI number — DR. JAMIE C IRWIN DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
IRWIN
Provider First Name:
JAMIE
Provider Middle Name:
C
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HEARNE
Provider Other First Name:
JAMIE
Provider Other Middle Name:
CHARLENE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DO
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1043413909
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/26/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 21850
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOT SPRINGS
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
71903-1850
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-767-9111
Provider Business Mailing Address Fax Number:
501-767-3433

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
225 MCAULEY CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOT SPRINGS
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
71913-6314
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-321-2546
Provider Business Practice Location Address Fax Number:
501-321-1838
Provider Enumeration Date:
06/07/2007

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: 208000000X , with the licence number:  E5512 , 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: 168836003 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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