1982691085 NPI number — DR. WILLIAM G COUTTS II MD

Table of content: DR. WILLIAM G COUTTS II MD (NPI 1982691085)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982691085 NPI number — DR. WILLIAM G COUTTS II MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COUTTS
Provider First Name:
WILLIAM
Provider Middle Name:
G
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
II
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1982691085
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/24/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 42
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKEVIEW
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72642-0042
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-431-4371
Provider Business Mailing Address Fax Number:
870-431-4376

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4898 HWY 178 W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKEVIEW
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72642
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-431-4371
Provider Business Practice Location Address Fax Number:
870-431-4376
Provider Enumeration Date:
10/04/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  E1525 , 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: 04030012400 . This is a "QUALCHOICE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 135062001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 206107609 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: E1525 . This is a "STATE LICENSE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 5K728 . This is a "BLUE CROSS" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: A008 . This is a "CHAMPUS" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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