1780697433 NPI number — NORTHWEST ARKANSAS PRIMARY CARE PHYSICIANS, PA

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 1780697433 NPI number — NORTHWEST ARKANSAS PRIMARY CARE PHYSICIANS, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHWEST ARKANSAS PRIMARY CARE PHYSICIANS, PA
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:
1780697433
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3400 SE MACY RD
Provider Second Line Business Mailing Address:
STE 18
Provider Business Mailing Address City Name:
BENTONVILLE
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72712-7841
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-845-0880
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3400 SE MACY RD
Provider Second Line Business Practice Location Address:
STE 18
Provider Business Practice Location Address City Name:
BENTONVILLE
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72712-7841
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-845-0880
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RAYMOND
Authorized Official First Name:
BRET
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF SALES/OPERATIONS
Authorized Official Telephone Number:
479-845-0880

Provider Taxonomy Codes

  • Taxonomy code: 305R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: E1802 . This is a "SUBMITTER NUMBER" identifier . This identifiers is of the category "OTHER".




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