Healthcare Provider Details

I. General information

NPI: 1720444334
Provider Name (Legal Business Name): NORTH ARKANSAS PAIN MANAGMENT PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2016
Last Update Date: 01/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 SIDNEY ST SUITE 200
BATESVILLE AR
72501-7203
US

IV. Provider business mailing address

PO BOX 95010
NORTH LITTLE ROCK AR
72190-5010
US

V. Phone/Fax

Practice location:
  • Phone: 870-262-3000
  • Fax:
Mailing address:
  • Phone: 501-771-4693
  • Fax: 501-771-4885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: TRACYE ENIS
Title or Position: BILLING MANAGER
Credential:
Phone: 501-771-4693