1821288184 NPI number — MS. BARBARA ELLEN DAVIS LAC

Table of content: MS. BARBARA ELLEN DAVIS LAC (NPI 1821288184)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821288184 NPI number — MS. BARBARA ELLEN DAVIS LAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAVIS
Provider First Name:
BARBARA
Provider Middle Name:
ELLEN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LAC
Provider Gender Code:
F

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:
1821288184
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/05/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
125 DONS WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOT SPRINGS
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
71913
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-620-5130
Provider Business Mailing Address Fax Number:
501-620-5109

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
505 W GRAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOT SPRINGS
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
71901-3931
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-624-7111
Provider Business Practice Location Address Fax Number:
501-620-5109
Provider Enumeration Date:
08/01/2007

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: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 116399726 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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