1811991193 NPI number — HEALTHWAY INC

Table of content: (NPI 1811991193)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811991193 NPI number — HEALTHWAY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTHWAY INC
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:
1811991193
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 804
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROGERS
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72757-0804
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-621-6151
Provider Business Mailing Address Fax Number:
479-621-0172

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1149 W WALNUT ST
Provider Second Line Business Practice Location Address:
STE B
Provider Business Practice Location Address City Name:
ROGERS
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72756-3543
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-621-6151
Provider Business Practice Location Address Fax Number:
479-621-0172
Provider Enumeration Date:
06/02/2005

Additional Information

Authorized Official

Authorized Official Last Name:
GRAY
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
WILLIAM
Authorized Official Title or Position:
OWNER, RESPIRATORY THERAPIST
Authorized Official Telephone Number:
479-621-6151

Provider Taxonomy Codes

  • Taxonomy code: 332BX2000X , with the licence number:  001669 , 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: 143544737 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 143543716 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 49761 . This is a "BLUECROSS/BLUESHIELD" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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