MEDICARE: ARKANSAS ALLERGY & ASTHMA CLINIC, P.A.

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	207K00000X	Allergy & Immunology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568423309
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARKANSAS ALLERGY & ASTHMA CLINIC, P.A.

Provider Business Mailing Address
First Line	:	2504 MCCAIN BLVD
Second Line	:	SUITE 118
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72116-7608
Country	:	US
Telephone Number	:	501-758-9696
Fax Number	:	501-758-4271

Provider Business Practice Location Address
First Line	:	2504 MCCAIN BLVD
Second Line	:	SUITE 118
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72116-7608
Country	:	US
Telephone Number	:	501-758-9696
Fax Number	:	501-758-4271

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MARY PRINCE
Credential	:
Telephone Number	:	501-758-9696

Provider Enumeration Date	:	03/31/2006
Last Update Date	:	07/14/2008

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