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General NPI Number Information
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NPI Number | 1255310066
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Entity Type | Organization
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Legal Business Name | ARKANSAS COUNTY ANESTHESIA AND PAIN MANAGEMENT, P.A.
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Dates
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Enumeration Date | 01/10/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1703 N BUERKLE ST SUITE 8
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City | STUTTGART
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State | AR
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Zip | 72160-3153
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Country | US
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Telephone | 870-674-6402
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 115
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City | STUTTGART
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State | AR
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Zip | 72160-0115
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Country | US
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Telephone | 870-674-6402
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Fax |
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Authorized Official
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Title or Position | MD
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Name | OLGA PAVLOVNA BLAKLEY
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Credential | MD
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Telephone | 870-674-6402
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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