Healthcare Provider Details

I. General information

NPI: 1184846065
Provider Name (Legal Business Name): ARKANSAS ORTHOPEDICS & SPORTS MEDICINE, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 03/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 W ERIE AVE
HARRISON AR
72601-3539
US

IV. Provider business mailing address

224 W ERIE AVE
HARRISON AR
72601-3539
US

V. Phone/Fax

Practice location:
  • Phone: 870-741-8289
  • Fax: 870-741-0308
Mailing address:
  • Phone: 870-741-8289
  • Fax: 870-741-0308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberE-5079
License Number StateAR

VIII. Authorized Official

Name: TARIK SIDANI
Title or Position: OWNER
Credential: D.O.
Phone: 870-741-8289