Alloplastic Reconstruction

Primary specialty

OcularistTaxonomy code 156FX1700X

Legal business name

ALLOPLASTIC RECONSTRUCTION

Practice address

3924 W Markham St
Little Rock, AR 72205-5528

Phone

(501) 265-0100

Fax

(501) 265-0102

NPI assigned

Oct 6, 2011

Organization subpart

No

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 5

Addresses

Medicare fee-for-service enrollment

Enrolled in AR2 enrollments

Enrollment records 2

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.

• Alloplastic Facial Reconstruction

  dba Alloplastic Reconstruction Inc

  • Customized Equipment (DME)
  • Little Rock, AR
  • NPI 1699957928
  NPD tax ID
• Real Life Skin

  • Customized Equipment (DME)
  • Little Rock, AR
  • NPI 1235413485
  NPD tax ID

Locations

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

{
    "created_epoch": "1317859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1537920000000",
    "number": "1598049744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3924 W MARKHAM ST",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722055528",
            "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": "3924 W MARKHAM ST",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722055528",
            "telephone_number": "501-265-0100",
            "fax_number": "501-265-0102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALLOPLASTIC RECONSTRUCTION",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-06",
        "last_updated": "2018-09-26",
        "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": "156FX1700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Technician/Technologist, Ocularist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "229N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anaplastologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "AR",
            "license": "OPP00038",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tyrone Allison
• Madison Alliston
• Naomi Louise Allmayer, OTR/L
• Gabrielle Nicole Allmon
• Alloplastic Facial Reconstruction (Alloplastic Reconstruction Inc)
• Alloplastic Restoration Foundation, Inc.
• Felix Nii Saka Allotey
• Ashley E Allred, MHPP
• Maurice Louie Allred, D.D.S.
• Mary Amanda Alls, LCSW

• Technician/Technologist in Little Rock, AR
• Providers in Little Rock, AR by specialty
• Technician/Technologist in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.