1366527145 NPI number — ASCENSION DEPAUL SERVICES

Table of content: (NPI 1366527145)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366527145 NPI number — ASCENSION DEPAUL SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASCENSION DEPAUL SERVICES
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:
1366527145
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/05/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 158
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DUMAS
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
71639-0158
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-382-3080
Provider Business Mailing Address Fax Number:
870-382-4895

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
145 W WATERMAN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DUMAS
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
71639-0158
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-382-4878
Provider Business Practice Location Address Fax Number:
870-382-4895
Provider Enumeration Date:
10/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
STEPHENSON
Authorized Official First Name:
LAURIE
Authorized Official Middle Name:
JAN
Authorized Official Title or Position:
DIRECTOR OF INTEGRATED SERVICES
Authorized Official Telephone Number:
870-382-3080

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 168849729 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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