1982963781 NPI number — MISS CALLIE MONTANA EFIRD

Table of content: MISS CALLIE MONTANA EFIRD (NPI 1982963781)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982963781 NPI number — MISS CALLIE MONTANA EFIRD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EFIRD
Provider First Name:
CALLIE
Provider Middle Name:
MONTANA
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
EFIRD
Provider Other First Name:
CALLIE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1982963781
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/01/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
187 APACHE TRL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DE QUEEN
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
71832-9228
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-584-7864
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
187 APACHE TRL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DE QUEEN
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
71832-9228
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-584-7864
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/14/2012

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: 2355S0801X , with the licence number:  251300000X , 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: 10-0115 . This is a "MEDICAID REGISTRATION NUMBER" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 187548795 . This is a "PRACTIONER ID NUMBER" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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