1770584393 NPI number — ARKANSAS VALLEY ANESTHESIA ASSOCIATES, P. A.

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 1770584393 NPI number — ARKANSAS VALLEY ANESTHESIA ASSOCIATES, P. A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARKANSAS VALLEY ANESTHESIA ASSOCIATES, P. A.
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:
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:
1770584393
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1351
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RUSSELLVILLE
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72811-1351
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
877-649-7812
Provider Business Mailing Address Fax Number:
918-392-2941

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1808 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RUSSELLVILLE
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72801-2724
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-968-2841
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/04/2005

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
C
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
501-454-8336

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , 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: 113665002 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 770090702 . This is a "AR BREASTCARE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: CC5970 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 57607 . This is a "BLUE CROSS BLUE SHIELD AR" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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