1801867122 NPI number — STEPHEN H ZIMMERMAN DPM

Table of content: STEPHEN H ZIMMERMAN DPM (NPI 1801867122)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801867122 NPI number — STEPHEN H ZIMMERMAN DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZIMMERMAN
Provider First Name:
STEPHEN
Provider Middle Name:
H
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPM
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:
1801867122
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/26/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
401 GRAHAM ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST MEMPHIS
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72301-3117
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-735-6500
Provider Business Mailing Address Fax Number:
870-735-4442

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
401 GRAHAM ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST MEMPHIS
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72301-3117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-735-6500
Provider Business Practice Location Address Fax Number:
870-735-4442
Provider Enumeration Date:
01/27/2006

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: 213E00000X , with the licence number:  120 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 213E00000X , with the licence number: 365 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 118596717 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 480010758 . This is a "MEDICARE ID TYPE UNSPECIFIED" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 480027256 . This is a "MEDICARE ID TYPE UNSPECIFIED" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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