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General NPI Number Information
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NPI Number | 1679830491
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Entity Type | Organization
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Legal Business Name | NORTHEAST ARKANSAS TREATMENT SERVICES, LLC
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Dates
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Enumeration Date | 04/18/2012
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Last Update Date | 12/01/2023
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Provider Practice Location Address
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Address Line | 912 OSLER DR STE C
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City | JONESBORO
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State | AR
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Zip | 72401-4330
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Country | US
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Telephone | 501-269-1395
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Fax | 501-246-5451
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Provider Business Mailing Address
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Address Line | 912 OSLER DR STE B
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City | JONESBORO
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State | AR
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Zip | 72401-4330
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Country | US
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Telephone | 870-336-0549
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/MEDICAL DIRECTOR
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Name | DR. PETER W. GURESKY
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Credential | MD
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Telephone | 870-336-0549
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2800X
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Taxonomy Name | Methadone Clinic
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License Number |
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License Number State |
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