Healthcare Provider Details

I. General information

NPI: 1831821040
Provider Name (Legal Business Name): PAIN MEDICINE SPECIALISTS OF ARKANSAS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2022
Last Update Date: 06/28/2022
Certification Date: 06/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 BRECKENRIDGE DR STE 106
LITTLE ROCK AR
72205-1565
US

IV. Provider business mailing address

PO BOX 9178
RUSSELLVILLE AR
72811-9178
US

V. Phone/Fax

Practice location:
  • Phone: 501-451-2500
  • Fax: 479-968-1673
Mailing address:
  • Phone: 800-824-4094
  • Fax: 479-968-1673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JULIO OLAYA
Title or Position: OWNER
Credential: MD
Phone: 501-231-0182