1356480818 NPI number — S & R CLINIC, PA

Table of content: (NPI 1356480818)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356480818 NPI number — S & R CLINIC, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
S & R CLINIC, PA
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:
1356480818
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/26/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 777
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WALNUT RIDGE
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72476-0777
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-886-8300
Provider Business Mailing Address Fax Number:
870-886-8302

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1045 W MAIN
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
WALNUT RIDGE
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72476
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-886-8300
Provider Business Practice Location Address Fax Number:
870-886-8302
Provider Enumeration Date:
02/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TROXEL
Authorized Official First Name:
ROGER
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
870-886-8300

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  C8313 , 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)





Copyright © 2007-2025 www.npivalidator.com