1205961083 NPI number — NORTH CENTRAL IV & RESPIRATORY SPECIALISTS LLC

Table of content: (NPI 1205961083)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205961083 NPI number — NORTH CENTRAL IV & RESPIRATORY SPECIALISTS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH CENTRAL IV & RESPIRATORY SPECIALISTS LLC
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:
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:
1205961083
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/10/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
202 E WASHINGTON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JONESBORO
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72401-3102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-932-0150
Provider Business Mailing Address Fax Number:
870-932-0150

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
202 E WASHINGTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JONESBORO
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72401-3102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-932-0150
Provider Business Practice Location Address Fax Number:
870-932-0150
Provider Enumeration Date:
02/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DARR
Authorized Official First Name:
JEREMY
Authorized Official Middle Name:
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
870-932-0150

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  AR20511 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X , with the licence number: AR20370 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 49868 . This is a "BCBS DME PROVIDER NUMBER" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 152028716 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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