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General NPI Number Information
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NPI Number | 1861972481
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Entity Type | Organization
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Legal Business Name | ID OF CENTRAL ARKANSAS, PLLC
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Dates
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Enumeration Date | 08/14/2018
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Last Update Date | 08/20/2018
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Provider Practice Location Address
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Address Line | 3500 SPRINGHILL DR STE 200B
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City | NORTH LITTLE ROCK
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State | AR
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Zip | 72117
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Country | US
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Telephone | 501-503-3000
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Fax | 501-503-0466
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Provider Business Mailing Address
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Address Line | 3500 SPRINGHILL DR STE 200B
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City | NORTH LITTLE ROCK
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State | AR
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Zip | 72117-2948
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Country | US
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Telephone | 501-503-3000
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Fax | 501-503-0466
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. AMANDA J NOVACK
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Credential | MD
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Telephone | 501-503-3000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number |
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License Number State |
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