1912949769 NPI number — METRO SPRINGDALE MED CENTER INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912949769 NPI number — METRO SPRINGDALE MED CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
METRO SPRINGDALE MED CENTER INC
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:
1912949769
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1670 W SUNSET AVE
Provider Second Line Business Mailing Address:
STE B
Provider Business Mailing Address City Name:
SPRINGDALE
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72764-5235
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-725-2555
Provider Business Mailing Address Fax Number:
479-725-2562

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1670 W SUNSET AVE
Provider Second Line Business Practice Location Address:
STE B
Provider Business Practice Location Address City Name:
SPRINGDALE
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72762-5136
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-725-2555
Provider Business Practice Location Address Fax Number:
479-725-2562
Provider Enumeration Date:
06/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DICKERSON
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
E
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
316-200-4424

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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