1255359931 NPI number — DR. JOHN KURT MEHL MD

Table of content: DR. JOHN KURT MEHL MD (NPI 1255359931)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255359931 NPI number — DR. JOHN KURT MEHL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEHL
Provider First Name:
JOHN
Provider Middle Name:
KURT
Provider Name Prefix Text:
DR.
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:
1255359931
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/30/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7001 ROGERS AVE
Provider Second Line Business Mailing Address:
SUITE 401
Provider Business Mailing Address City Name:
FORT SMITH
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72903-4073
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-314-4650
Provider Business Mailing Address Fax Number:
479-452-9459

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7001 ROGERS AVE
Provider Second Line Business Practice Location Address:
SUITE 401
Provider Business Practice Location Address City Name:
FORT SMITH
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72903-4073
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-314-4650
Provider Business Practice Location Address Fax Number:
479-452-9459
Provider Enumeration Date:
07/18/2006

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: 207RI0011X , with the licence number:  N-8282 , 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: 060019708 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 121610001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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