1184676538 NPI number — DERMATOLOGY GROUP OF ARKANSAS, P.A.

Table of content: (NPI 1184676538)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184676538 NPI number — DERMATOLOGY GROUP OF ARKANSAS, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DERMATOLOGY GROUP OF ARKANSAS, P.A.
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:
1184676538
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/30/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9601 BAPTIST HEALTH DR.
Provider Second Line Business Mailing Address:
SUITE 690
Provider Business Mailing Address City Name:
LITTLE ROCK
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72205-6328
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-227-8422
Provider Business Mailing Address Fax Number:
501-537-2399

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9601 BAPTIST HEALTH DR.
Provider Second Line Business Practice Location Address:
SUITE 690
Provider Business Practice Location Address City Name:
LITTLE ROCK
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72205-6328
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-227-8422
Provider Business Practice Location Address Fax Number:
501-537-2399
Provider Enumeration Date:
05/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DAMROW
Authorized Official First Name:
DINA
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE ADMINISTRATOR
Authorized Official Telephone Number:
501-227-8422

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207NP0225X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 070003037 . This is a "TRAVELERS MEDICARE#" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 132088008 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com