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NPI Code Detail

MEDICARE: CENTRAL ARKANSAS PHYSICIAN GROUP PLLC

MEDICARE: CENTRAL ARKANSAS PHYSICIAN GROUP PLLC
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
1207R00000XInternal Medicine Physician

General Provider Information

NPI Number : 1205718897
Entity Type Code : Organization
Provider Name (Legal Business Name) : CENTRAL ARKANSAS PHYSICIAN GROUP PLLC
Provider Business Mailing Address
First Line : PO BOX 1128
Second Line :
City : SEARCY
State : AR
Zip : 72145-1128
Country : US
Telephone Number :
Fax Number : 855-897-8849
Provider Business Practice Location Address
First Line : 3214 E RACE AVE
Second Line :
City : SEARCY
State : AR
Zip : 72143-4810
Country : US
Telephone Number : 719-229-3849
Fax Number : 702-977-1496
Authorized Official
Title or Position : ACCOUNT MANAGER
Name : DR. CARLA REVILLA
Credential :
Telephone Number : 719-229-3849
Provider Enumeration Date : 07/23/2025
Last Update Date : 04/07/2026

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