1730421454 NPI number — ARTINELI FOOT CARE SOLUTIONS PLLC

Table of content: (NPI 1730421454)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730421454 NPI number — ARTINELI FOOT CARE SOLUTIONS PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARTINELI FOOT CARE SOLUTIONS PLLC
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:
1730421454
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/20/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 21
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTHAVEN
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
38671-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-500-5103
Provider Business Mailing Address Fax Number:
901-310-9117

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
801 TECHNOLOGY DRIVE, SUITE D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LITTLE ROCK
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72223
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-500-5103
Provider Business Practice Location Address Fax Number:
901-310-9117
Provider Enumeration Date:
03/20/2013

Additional Information

Authorized Official

Authorized Official Last Name:
GRIFFIN
Authorized Official First Name:
SHANTA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PODIATRIST
Authorized Official Telephone Number:
901-500-5103

Provider Taxonomy Codes

  • Taxonomy code: 261QP1100X , with the licence number:  252 , 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)





Copyright © 2007-2025 www.npivalidator.com