MEDICARE: ON THE GO MED INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	E3929	AR

General Provider Information

NPI Number	:	1013188036
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ON THE GO MED INC

Provider Business Mailing Address
First Line	:	11321 I-30 STE 304
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72209-7067
Country	:	US
Telephone Number	:	501-455-9500
Fax Number	:	501-455-9505

Provider Business Practice Location Address
First Line	:	11321 I-30 STE 304
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72209-7067
Country	:	US
Telephone Number	:	501-455-9500
Fax Number	:	501-455-9505

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	BARBARA G WOODS PERRY
Credential	:	MD
Telephone Number	:	501-455-9500

Provider Enumeration Date	:	03/18/2008
Last Update Date	:	03/18/2008

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Directions to “ON THE GO MED INC ” Practice Location

Language	Start Address	Practice Location

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