1679657522 NPI number — MR. THOMAS R BUTLER DC

Table of content: MR. THOMAS R BUTLER DC (NPI 1679657522)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679657522 NPI number — MR. THOMAS R BUTLER DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUTLER
Provider First Name:
THOMAS
Provider Middle Name:
R
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
M

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:
1679657522
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
811 RANCH HOUSE PLAZA
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARRISON
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-741-4408
Provider Business Mailing Address Fax Number:
870-741-4409

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
811 RANCH HOUSE PLAZA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARRISON
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-741-4408
Provider Business Practice Location Address Fax Number:
870-741-4409
Provider Enumeration Date:
10/25/2006

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: 111N00000X , with the licence number:  905 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 111N00000X , with the licence number: 4364 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 59066 . This is a "BCBS" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com