MEDICARE: NES ARKANSAS, INC.

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	207P00000X	Emergency Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5C808	OTHER	AR	GROUP BCBS NUMBER

General Provider Information

NPI Number	:	1184615551
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NES ARKANSAS, INC.

Provider Business Mailing Address
First Line	:	PO BOX 403234
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30384-3234
Country	:	US
Telephone Number	:	800-377-8721
Fax Number	:	304-523-2241

Provider Business Practice Location Address
First Line	:	700 W GROVE ST
Second Line	:
City	:	EL DORADO
State	:	AR
Zip	:	71730-4416
Country	:	US
Telephone Number	:	870-863-2200
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	VINCENT MORRA
Credential	:
Telephone Number	:	800-377-8721

Provider Enumeration Date	:	11/03/2005
Last Update Date	:	07/19/2007

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