1821156035 NPI number — NEPHROPATHOLOGY ASSOCIATES, PLC

Table of content: (NPI 1821156035)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821156035 NPI number — NEPHROPATHOLOGY ASSOCIATES, PLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEPHROPATHOLOGY ASSOCIATES, PLC
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:
ARKANA LABORATORIES
Provider Other Organization Name Type Code:
3
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:
1821156035
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/08/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10810 EXECUTIVE CENTER DR
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
LITTLE ROCK
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72211-4386
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-604-2695
Provider Business Mailing Address Fax Number:
501-604-2699

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10810 EXECUTIVE CENTER DR
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
LITTLE ROCK
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72211-4386
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-604-2695
Provider Business Practice Location Address Fax Number:
501-604-2699
Provider Enumeration Date:
12/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LARSEN
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
PATRICK
Authorized Official Title or Position:
EXECUTIVE DIRECTOR, OWNER
Authorized Official Telephone Number:
501-604-2695

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0101X , with the licence number:  MC-2034 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 291U00000X , with the licence number: MC-2034 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 272534 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: L00307 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 912012200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 95323287 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 368483 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 807547100 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3810017266B , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 529911940 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: N210291 . This is a "WELLCARE, FL HEALTHEASE ONLY" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1504795 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 210587601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200279440 A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 120142400 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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