Healthcare Provider Details

I. General information

NPI: 1255310066
Provider Name (Legal Business Name): ARKANSAS COUNTY ANESTHESIA AND PAIN MANAGEMENT, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1703 N BUERKLE ST SUITE 8
STUTTGART AR
72160-3153
US

IV. Provider business mailing address

PO BOX 115
STUTTGART AR
72160-0115
US

V. Phone/Fax

Practice location:
  • Phone: 870-674-6402
  • Fax:
Mailing address:
  • Phone: 870-674-6402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: OLGA PAVLOVNA BLAKLEY
Title or Position: MD
Credential: MD
Phone: 870-674-6402