1790905297 NPI number — ARC THERAPY SERVICES LLC

Table of content: (NPI 1790905297)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790905297 NPI number — ARC THERAPY SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARC THERAPY SERVICES LLC
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:
1790905297
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/09/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 WESTWOOD PL
Provider Second Line Business Mailing Address:
STE 400
Provider Business Mailing Address City Name:
BRENTWOOD
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37027-5057
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-221-2250
Provider Business Mailing Address Fax Number:
615-221-2280

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1880 E RIVER RD
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85718-5994
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-219-1649
Provider Business Practice Location Address Fax Number:
520-219-2390
Provider Enumeration Date:
04/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
EVANS
Authorized Official First Name:
DONNIS
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
MANAGER, REGULATORY PRACTICES
Authorized Official Telephone Number:
615-564-8181

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  HHA4238 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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