1871990937 NPI number — THE PAIN MEDICINE CONSULTANTS GROUP

Table of content: (NPI 1871990937)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871990937 NPI number — THE PAIN MEDICINE CONSULTANTS GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE PAIN MEDICINE CONSULTANTS GROUP
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:
1871990937
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/07/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 242807
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:
72223-0032
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-217-4000
Provider Business Mailing Address Fax Number:
501-217-4022

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2425 DAVE WARD DR
Provider Second Line Business Practice Location Address:
GORDY BUILDING STE 102
Provider Business Practice Location Address City Name:
CONWAY
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72034-8686
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-764-1150
Provider Business Practice Location Address Fax Number:
501-764-1153
Provider Enumeration Date:
12/04/2014

Additional Information

Authorized Official

Authorized Official Last Name:
ACKERMAN
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
E
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
501-217-4000

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  E-0337 , 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)





Copyright © 2007-2024 www.npivalidator.com