1164416640 NPI number — SAMUEL H ARNOLD III D O

Table of content: SAMUEL H ARNOLD III D O (NPI 1164416640)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164416640 NPI number — SAMUEL H ARNOLD III D O

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ARNOLD
Provider First Name:
SAMUEL
Provider Middle Name:
H
Provider Name Prefix Text:
Provider Name Suffix Text:
III
Provider Credential Text:
D O
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:
1164416640
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/25/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1316 S HIGHWAY 7
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPARKMAN
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
71763-8674
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-807-4255
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
404 S BRADLEY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WARREN
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
71671-3459
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-226-3731
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/09/2005

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: 208600000X , with the licence number:  E-2458 , 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: 1164416640 . This is a "QUALCHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5181488 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 141442003 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 207122 . This is a "HEALTHLINK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0000129360506 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 020053473 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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