Healthcare Provider Details

I. General information

NPI: 1154934016
Provider Name (Legal Business Name): MIKE S MCFARLAND MDPA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2020
Last Update Date: 08/28/2020
Certification Date: 08/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9800 BAPTIST HEALTH DR STE 301
LITTLE ROCK AR
72205-6230
US

IV. Provider business mailing address

3805 W 28TH AVE
PINE BLUFF AR
71603-4774
US

V. Phone/Fax

Practice location:
  • Phone: 501-225-4488
  • Fax:
Mailing address:
  • Phone: 870-536-4100
  • Fax: 870-534-3982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AMY OFFUTT
Title or Position: CONTROLLER
Credential:
Phone: 870-536-4100