Healthcare Provider Details

I. General information

NPI: 1114992047
Provider Name (Legal Business Name): ARKANSAS NEPHROLOGY SERVICES, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 07/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1114 WASHINGTON N.W.
CAMDEN AR
71701-3827
US

IV. Provider business mailing address

115 WRIGHTS ST
HOT SPRINGS AR
71913-6240
US

V. Phone/Fax

Practice location:
  • Phone: 870-837-1330
  • Fax: 870-837-1423
Mailing address:
  • Phone: 501-624-6000
  • Fax: 501-321-0710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. DONETTE LIGON
Title or Position: ADMINISTRATOR
Credential:
Phone: 501-624-6000