1407825847 NPI number — MRS. SARAH ANN OWERS CRNA

Table of content: CHANDLER MILLER PT (NPI 1366090268)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407825847 NPI number — MRS. SARAH ANN OWERS CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OWERS
Provider First Name:
SARAH
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

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:
1407825847
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/06/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
894 THOMPSON BAY LOOP
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW BLAINE
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72851
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-938-1030
Provider Business Mailing Address Fax Number:
479-938-7734

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ONE CHOCTAW WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TALIHINA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74571
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-567-7000
Provider Business Practice Location Address Fax Number:
918-567-7090
Provider Enumeration Date:
03/17/2006

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: 367500000X , with the licence number:  R0082284 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 145705701 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 303853000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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