1366658346 NPI number — ELIZABETH WEBB IRBY D.O.

Table of content: ELIZABETH WEBB IRBY D.O. (NPI 1366658346)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366658346 NPI number — ELIZABETH WEBB IRBY D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
IRBY
Provider First Name:
ELIZABETH
Provider Middle Name:
WEBB
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WEBB
Provider Other First Name:
ELIZABETH
Provider Other Middle Name:
WEBB
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DO
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1366658346
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/27/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11001 EXECUTIVE CENTER DRIVE
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
LITTLE ROCK
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72211
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-812-7587
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11719 HINSON ROAD
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
LITTLE ROCK
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-224-2875
Provider Business Practice Location Address Fax Number:
201-221-9251
Provider Enumeration Date:
05/15/2007

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: 207Q00000X , with the licence number:  E-6739 , 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: 185541003 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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