1811047160 NPI number — DR. LISA M. MCGILL LINSON PH.D.

Table of content: DR. LISA M. MCGILL LINSON PH.D. (NPI 1811047160)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811047160 NPI number — DR. LISA M. MCGILL LINSON PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LINSON
Provider First Name:
LISA
Provider Middle Name:
M. MCGILL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
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:
1811047160
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/14/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
33 CONGRESSIONAL CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LITTLE ROCK
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72210-2851
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-225-3226
Provider Business Mailing Address Fax Number:
501-257-3125

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2200 FORT ROOTS DR
Provider Second Line Business Practice Location Address:
BUILDING 170 - 2H132
Provider Business Practice Location Address City Name:
NORTH LITTLE ROCK
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-257-3317
Provider Business Practice Location Address Fax Number:
501-257-3125
Provider Enumeration Date:
01/11/2007

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: 103TC0700X , with the licence number:  06-40P , 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)





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