Basic Information
| Provider Information | |||||||||
| NPI: | 1134217441 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BARTTER | ||||||||
| FirstName: | THADDEUS | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4301 W MARKHAM ST # 555 | ||||||||
| Address2: | |||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722057101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016868000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4301 W MARKHAM ST # 555 | ||||||||
| Address2: | |||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722057101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016868000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2006 | ||||||||
| LastUpdateDate: | 02/23/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0200X | MA52357 | NJ | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RC0200X | MD044300E | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RP1001X | MA52357 | NJ | N | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207RP1001X | MD0443000E | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207RP1001X | E-5847 | AR | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | P440699 | 01 | OXFORD HEALTH PLAN | OTHER | 0255871000 | 01 | AMERIHEALTH ,HMO KEYSTONE, IBC | OTHER | 3K6149 | 01 | HEALTHNET | OTHER | 84039 | 01 | AMERIGROUP | OTHER | 123444 | 01 | AETNA | OTHER | 1037896 | 01 | HORIZON NJ HEALTH | OTHER | 1242870 | 01 | UNITED HEALTH CARE | OTHER | 3903171 | 01 | CIGNA | OTHER | 3992101 | 05 | NJ | MEDICAID | CA0000028 02 | 01 | AMERICHOICE | OTHER | 110084234 | 01 | RAIL RAOD MEDICARE | OTHER | 196463 | 01 | AMERIHEALTH PPO | OTHER | 42403 | 01 | UNIVERSITY HEALTH PLAN | OTHER |