1134140601 NPI number — DR. BETHANY ANNE WINTHER GALIMORE D.C.

Table of content: DR. BETHANY ANNE WINTHER GALIMORE D.C. (NPI 1134140601)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134140601 NPI number — DR. BETHANY ANNE WINTHER GALIMORE D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WINTHER GALIMORE
Provider First Name:
BETHANY
Provider Middle Name:
ANNE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
F

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:
1134140601
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/16/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
501 CASS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CENTERTON
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72719-9677
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-286-2528
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1720 S WALTON BLVD STE 6
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BENTONVILLE
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72712-7533
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-464-0834
Provider Business Practice Location Address Fax Number:
479-464-0836
Provider Enumeration Date:
07/21/2006

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: 111N00000X , with the licence number:  2003009842 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111N00000X , with the licence number: 16243 , 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)





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