Healthcare Provider Details

I. General information

NPI: 1386958429
Provider Name (Legal Business Name): ARKANSAS ORTHOPEDIC AND SPINE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2010
Last Update Date: 07/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

823 N MAIN ST SUITE 3
HARRISON AR
72601-2914
US

IV. Provider business mailing address

PO BOX 861
HARRISON AR
72602-0861
US

V. Phone/Fax

Practice location:
  • Phone: 870-704-9677
  • Fax: 479-770-5656
Mailing address:
  • Phone: 479-770-5656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: ANGELILAH BEJERANO
Title or Position: PRESIDENT
Credential:
Phone: 870-704-9677