Healthcare Provider Details

I. General information

NPI: 1407068562
Provider Name (Legal Business Name): ARKANSAS BACK INSTITUTE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 07/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 DAVE WARD DRIVE SUITE 201
CONWAY AR
72034
US

IV. Provider business mailing address

PO BOX 10660
CONWAY AR
72034-0011
US

V. Phone/Fax

Practice location:
  • Phone: 501-329-7246
  • Fax: 501-329-3900
Mailing address:
  • Phone: 501-329-7246
  • Fax: 501-329-3900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberN-7842
License Number StateAR

VIII. Authorized Official

Name: DAVID MICHAEL ARNOLD
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 501-329-7246