Healthcare Provider Details

I. General information

NPI: 1346534047
Provider Name (Legal Business Name): ARKANSAS FOOT & ANKLE CLINIC, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2011
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 W 40TH AVE SUITE 4E
PINE BLUFF AR
71603-6940
US

IV. Provider business mailing address

1801 W 40TH AVE SUITE 4E
PINE BLUFF AR
71603-6940
US

V. Phone/Fax

Practice location:
  • Phone: 870-535-4850
  • Fax: 870-535-3558
Mailing address:
  • Phone: 870-535-4850
  • Fax: 870-535-3558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number162
License Number StateAR

VIII. Authorized Official

Name: DR. JOHN P THRASH
Title or Position: DOCTOR
Credential:
Phone: 870-535-4850