1508953449 NPI number — NEWTON COUNTY HEALTHCARE ASSOCIATION INC

Table of content: (NPI 1508953449)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508953449 NPI number — NEWTON COUNTY HEALTHCARE ASSOCIATION INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEWTON COUNTY HEALTHCARE ASSOCIATION 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:
1508953449
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/03/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 442
Provider Second Line Business Mailing Address:
610 EAST COURT ST
Provider Business Mailing Address City Name:
JASPER
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72641-0442
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-446-2333
Provider Business Mailing Address Fax Number:
870-446-5133

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
610 EAST COURT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JASPER
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72641-0442
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-446-2333
Provider Business Practice Location Address Fax Number:
870-446-5133
Provider Enumeration Date:
10/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DUNCAN
Authorized Official First Name:
LISA
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
870-446-2333

Provider Taxonomy Codes

  • Taxonomy code: 313M00000X , with the licence number:  645 , 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: 119655311 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0534 . This is a "STATE VENDOR NUMBER" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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