1851347264 NPI number — NEWPORT RADIOLOGY CONSULTANTS PA

Table of content: DR. KATHLEEN LUCILLE OLSON M.D. (NPI 1952355836)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851347264 NPI number — NEWPORT RADIOLOGY CONSULTANTS PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEWPORT RADIOLOGY CONSULTANTS PA
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:
1851347264
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1270
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWPORT
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72112-1270
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-523-6592
Provider Business Mailing Address Fax Number:
870-523-0137

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1205 MCLAIN ST
Provider Second Line Business Practice Location Address:
DEPT. OF RADIOLOGY
Provider Business Practice Location Address City Name:
NEWPORT
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72112-3533
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-523-6592
Provider Business Practice Location Address Fax Number:
870-523-0137
Provider Enumeration Date:
05/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CHAUHAN
Authorized Official First Name:
MUFIZ
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
870-523-6592

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  NA , 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: NO ID UNDER SSN . This is a "BCBSAR" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 1851347264 . This is a "AR TUBERCULOSIS PROGRAM" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: NO ID UNDER INDIVIDU , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: S03116 . This is a "NOVASYS HEALTH" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 1241350 . This is a "CIGNA" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 770064602 . This is a "AR BREASTCARE PROGRAM" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 172345000 . This is a "US DEPT OF LABOR" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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