1902950116 NPI number — DAVID W FURR LLC

Table of content: (NPI 1902950116)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902950116 NPI number — DAVID W FURR LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAVID W FURR LLC
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:
6
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:
1902950116
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/15/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 11407
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35246-1555
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-427-3760
Provider Business Mailing Address Fax Number:
918-427-0081

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
307 E RAY FINE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROLAND
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74954-5160
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-427-3760
Provider Business Practice Location Address Fax Number:
918-427-0081
Provider Enumeration Date:
01/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FURR
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
WAYNE
Authorized Official Title or Position:
PHYSICIAN OWNER
Authorized Official Telephone Number:
479-420-6618

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  3855 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X , with the licence number: E-3777 , 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: 100072520-C , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9R067 . This is a "BLUE CROSS BLUE SHIELD AR" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 150957003 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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