Provider Demographics
NPI:1225140585
Name:CHARLES W. HIMMLER, D.O.,P.A.
Entity Type:Organization
Organization Name:CHARLES W. HIMMLER, D.O.,P.A.
Other - Org Name:HIMMLER MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:W
Authorized Official - Last Name:HIMMLER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:501-796-8484
Mailing Address - Street 1:1159 MAIN ST
Mailing Address - Street 2:P.O. BOX 359
Mailing Address - City:VILONIA
Mailing Address - State:AR
Mailing Address - Zip Code:72173-9525
Mailing Address - Country:US
Mailing Address - Phone:501-796-8484
Mailing Address - Fax:501-796-2453
Practice Address - Street 1:1159 MAIN ST
Practice Address - Street 2:
Practice Address - City:VILONIA
Practice Address - State:AR
Practice Address - Zip Code:72173-9525
Practice Address - Country:US
Practice Address - Phone:501-796-8484
Practice Address - Fax:501-796-2453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
080017971OtherRR MEDICARE