1710773593 NPI number — MAHNOOR JALIL MBBS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710773593 NPI number — MAHNOOR JALIL MBBS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JALIL
Provider First Name:
MAHNOOR
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MBBS
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:
1710773593
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/04/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
01/28/2026
NPI Reactivation Date:
03/04/2026

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7301 ROGERS AVENUE
Provider Second Line Business Mailing Address:
MERCY HOSPITAL FORT SMITH, GRADUATE MEDICAL EDUCATION
Provider Business Mailing Address City Name:
FORT SMITH
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72903
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-573-3838
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7003 CHAD COLLEY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARLING
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72923
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-431-3500
Provider Business Practice Location Address Fax Number:
479-452-2098
Provider Enumeration Date:
04/17/2025

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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