NPIMap

Organization Active NPI

Real Life Skin

  • Customized Equipment (DME)
  • Little Rock, AR
National Provider Identifier
1235413485
Registry record updated Oct 6, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Customized Equipment (DME)Taxonomy code 332BC3200X
Legal business name
REAL LIFE SKIN
Practice address
220 N Van Buren St
Little Rock, AR 72205-3650
Phone
(501) 265-0100
Fax
(501) 265-0102
NPI assigned
Oct 6, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Michael Kaczkowski
Title
President
Phone
(501) 265-0100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Customized Equipment (DME) 332BC3200X Primary

Addresses

Primary practice location

220 N Van Buren St
Little Rock, AR 72205-3650

Mailing address

P O Box 56182
Little Rock, AR 72215-6182
Phone (501) 265-0100

National Provider Directory

National Provider Directory
Tax ID family
Real Life Skin3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1317859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1317859200000",
    "number": "1235413485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P O BOX 56182",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722156182",
            "telephone_number": "501-265-0100",
            "fax_number": "501-265-0102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 N VAN BUREN ST",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722053650",
            "telephone_number": "501-265-0100",
            "fax_number": "501-265-0102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REAL LIFE SKIN",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-06",
        "last_updated": "2011-10-06",
        "status": "A",
        "authorized_official_last_name": "KACZKOWSKI",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "501-265-0100",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Little Rock, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.