Healthcare Provider Details

I. General information

NPI: 1538522347
Provider Name (Legal Business Name): CENTRAL ARKANSAS SPINE SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2016
Last Update Date: 03/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 MEDICAL PARK DR STE 308
BENTON AR
72015-3729
US

IV. Provider business mailing address

5 MEDICAL PARK DR STE 308
BENTON AR
72015-3729
US

V. Phone/Fax

Practice location:
  • Phone: 501-776-6252
  • Fax: 501-776-6271
Mailing address:
  • Phone: 501-776-6252
  • Fax: 501-776-6271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANNA KIPP
Title or Position: DIRECTOR OF PHYSICIAN SERVICES
Credential:
Phone: 501-776-6093