MEDICARE: ARKANSAS RHEUMATOLOGY CENTER, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RR0500X	Rheumatology Physician	BL150264	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	BL150264	OTHER	AR	BUSINESS LICENSE

General Provider Information

NPI Number	:	1093137507
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARKANSAS RHEUMATOLOGY CENTER, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 55630
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72215-5630
Country	:	US
Telephone Number	:	501-217-9382
Fax Number	:	501-217-1692

Provider Business Practice Location Address
First Line	:	9101 KANIS RD
Second Line	:	SUITE 203
City	:	LITTLE ROCK
State	:	AR
Zip	:	72205-6456
Country	:	US
Telephone Number	:	501-217-9382
Fax Number	:	501-217-1692

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. MARION YORK
Credential	:
Telephone Number	:	501-227-7688

Provider Enumeration Date	:	01/17/2014
Last Update Date	:	01/17/2014

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