1972614345 NPI number — ASSOCIATES PHYSICAL THERAPY AND PAIN MANAGEMENT

Table of content: (NPI 1972614345)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972614345 NPI number — ASSOCIATES PHYSICAL THERAPY AND PAIN MANAGEMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASSOCIATES PHYSICAL THERAPY AND PAIN MANAGEMENT
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:
1972614345
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/03/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11900 KANIS RD
Provider Second Line Business Mailing Address:
SUITE D4
Provider Business Mailing Address City Name:
LITTLE ROCK
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72211
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-687-0851
Provider Business Mailing Address Fax Number:
501-687-0853

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11900 KANIS RD
Provider Second Line Business Practice Location Address:
SUITE D4
Provider Business Practice Location Address City Name:
LITTLE ROCK
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-687-0851
Provider Business Practice Location Address Fax Number:
501-687-0853
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TUMLISON
Authorized Official First Name:
NATHAN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
501-687-0851

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5W154 . This is a "THOMAS P. BATES-BLUE CROS" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 156654721 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00222774 . This is a "THOMAS P. BATES-RAILROAD" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 150763742 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5V266C883 . This is a "MARY PERSSON - MEDICARE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 5X452 . This is a "NATHAN TUMLISON-BLUE CROS" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 5V266 . This is a "MARY PERSSON - BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: P00094056 . This is a "NATHAN TUMLISON-RAILROAD" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com