1316180284 NPI number — PARAGOULD OBSTETRICS AND GYNECOLOGY, PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316180284 NPI number — PARAGOULD OBSTETRICS AND GYNECOLOGY, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PARAGOULD OBSTETRICS AND GYNECOLOGY, PLLC
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:
1316180284
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/08/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 W. KINGSHIGHWAY
Provider Second Line Business Mailing Address:
SUITE 4
Provider Business Mailing Address City Name:
PARAGOULD
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72450
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-239-3225
Provider Business Mailing Address Fax Number:
870-239-3595

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 W. KINGSHIGHWAY
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
PARAGOULD
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72450
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-239-3225
Provider Business Practice Location Address Fax Number:
870-239-3595
Provider Enumeration Date:
04/08/2009

Additional Information

Authorized Official

Authorized Official Last Name:
HASIK
Authorized Official First Name:
KARL
Authorized Official Middle Name:
JOSEPH
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
870-239-3225

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  E1083 , 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)





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