1366522039 NPI number — MILESTONES SERVICES, INC.

Table of content: (NPI 1366522039)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366522039 NPI number — MILESTONES SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MILESTONES SERVICES, INC.
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:
1366522039
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/06/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 219
Provider Second Line Business Mailing Address:
1700 SOUTH BOULEVARD
Provider Business Mailing Address City Name:
CONWAY
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72033-0219
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-329-2164
Provider Business Mailing Address Fax Number:
501-329-2113

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1700 SOUTH BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CONWAY
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72034-6455
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-329-2164
Provider Business Practice Location Address Fax Number:
501-329-2113
Provider Enumeration Date:
10/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
OHLDE
Authorized Official First Name:
RANDALL
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
501-329-8102

Provider Taxonomy Codes

  • Taxonomy code: 251C00000X , 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: 130523774 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 125900767 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 116441742 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 132513786 . This is a "STATE FUNDS" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 158094771 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 102217724 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 140200724 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 115073715 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 145750778 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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