1881870616 NPI number — SPEARS PROSTHETICS AND ORTHOTICS

Table of content: (NPI 1881870616)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881870616 NPI number — SPEARS PROSTHETICS AND ORTHOTICS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPEARS PROSTHETICS AND ORTHOTICS
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:
1881870616
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 770237
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEMPHIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38177-0237
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2000 HIGHWAY 25B
Provider Second Line Business Practice Location Address:
SUITE C-1
Provider Business Practice Location Address City Name:
HEBER SPRINGS
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72543-6417
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-206-3500
Provider Business Practice Location Address Fax Number:
501-206-3505
Provider Enumeration Date:
01/10/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SPEARS
Authorized Official First Name:
MICAH
Authorized Official Middle Name:
B
Authorized Official Title or Position:
PRESIDENT/ CPO
Authorized Official Telephone Number:
501-206-3500

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X , 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: 49849 . This is a "BCBS" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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