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General NPI Number Information
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NPI Number | 1912121252
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Entity Type | Organization
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Legal Business Name | CHILDREN'S HEALTHCARE CLINIC OF SOUTH ARKANSAS
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 704 W GROVE SUITE 4
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City | EL DORADO
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State | AR
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Zip | 71730
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Country | US
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Telephone | 870-862-8034
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Fax | 870-862-9476
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Provider Business Mailing Address
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Address Line | 704 W GROVE SUITE 4
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City | EL DORADO
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State | AR
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Zip | 71730
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Country | US
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Telephone | 870-862-8034
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Fax | 870-862-9476
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Authorized Official
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Title or Position | OFFICE CO-ORDINATOR
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Name | MS. LORNA JAYNE ANAYA
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Credential |
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Telephone | 870-862-8034
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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