The Gregory Kistler Treatment Center, Inc.

Primary specialty

Voluntary or Charitable AgencyTaxonomy code 251V00000X

Legal business name

THE GREGORY KISTLER TREATMENT CENTER, INC.

Practice address

3304 S M St
Fort Smith, AR 72903-2903

Phone

(479) 785-4677

Fax

(479) 785-4673

NPI assigned

Mar 21, 2006

Last updated

Aug 13, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Jennifer Kistler

Title

Executive Director

Phone

(479) 785-4677

Specialties & licenses 1

Addresses

Other identifiers 5

Tax ID family

The Gregory Kistler Treatment Center Inc3 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.

• The Gregory Kistler Treatment Center, Inc.

  • Durable Medical Equipment & Medical Supplies
  • Fort Smith, AR
  • NPI 1356307615
  NPD tax ID
• The Gregory Kistler Treatment Center, Inc.

  • Voluntary or Charitable Agency
  • Fort Smith, AR
  • NPI 1841823200
  NPD tax ID

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Krista Hannaman

  • Occupational Therapy Assistant
  • Fort Smith, AR
  • NPI 1396707824
  NPD (past)
• Robert Gary Mack II, BACHELOR

  • Contractor
  • Greenwood, AR
  • NPI 1619018793
  NPD (past)
• Kasey McMahen, M.S., CCC-SLP

  • Speech-Language Pathologist
  • Fort Smith, AR
  • NPI 1720204571
  NPD (past)
• Kristen Ricketts

  • Physical Therapist
  • Fort Smith, AR
  • NPI 1487727558
  NPD (past)
• Lavonda Ann Hensley, L.P.T.A.

  • Physical Therapy Assistant
  • Roland, OK
  • NPI 1609840123
  NPD (past)

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

{
    "created_epoch": "1142899200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1344816000000",
    "number": "1437118015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3304 S M ST",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729032903",
            "telephone_number": "479-785-4677",
            "fax_number": "479-785-4673"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3304 S M ST",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729032903",
            "telephone_number": "479-785-4677",
            "fax_number": "479-785-4673"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE GREGORY KISTLER TREATMENT CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-21",
        "last_updated": "2012-08-13",
        "status": "A",
        "authorized_official_last_name": "KISTLER",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "479-785-4677",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "251V00000X",
            "taxonomy_group": "",
            "desc": "Voluntary or Charitable",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1000679370D",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS DME",
            "identifier": "47953",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "115951742",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "117606716",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS TREATMENT",
            "identifier": "5B311",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• The Gregory Kistler Treatment Center, Inc.
• The Gregory Kistler Treatment Center, Inc.
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• Voluntary or Charitable Agency in Fort Smith, AR
• Providers in Fort Smith, AR by specialty
• Voluntary or Charitable Agency in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2012; 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.