1144268061 NPI number — KIMITAKA SAITO MD

Table of content: KIMITAKA SAITO MD (NPI 1144268061)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144268061 NPI number — KIMITAKA SAITO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SAITO
Provider First Name:
KIMITAKA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1144268061
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/28/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 616
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARKED TREE
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72365-0616
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-358-4355
Provider Business Mailing Address Fax Number:
870-358-4357

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
202 NEWSOME DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARKED TREE
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72365-2021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-358-4355
Provider Business Practice Location Address Fax Number:
870-358-4357
Provider Enumeration Date:
06/03/2006

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: 207Q00000X , with the licence number:  R-2736 , 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: 710852165-001 . This is a "PRUDENTIAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7052174 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 17411000000 . This is a "QUALCHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 54639 . This is a "ARBCBS" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 710852165-001 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".




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