Healthcare Provider Details

I. General information

NPI: 1093060824
Provider Name (Legal Business Name): PHYSICIAN GROUP OF ARKANSAS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2012
Last Update Date: 03/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 S MAIN ST
HOPE AR
71801-8124
US

IV. Provider business mailing address

PO BOX 842109
DALLAS TX
75284-2109
US

V. Phone/Fax

Practice location:
  • Phone: 870-777-2323
  • Fax: 870-722-7158
Mailing address:
  • Phone: 866-286-2802
  • Fax: 314-432-9683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN A DEMKE
Title or Position: CEO
Credential:
Phone: 615-467-1072