MEDICARE: JAIARKA LLC

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	207Y00000X	Otolaryngology Physician

General Provider Information

NPI Number	:	1730844168
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAIARKA LLC

Provider Business Mailing Address
First Line	:	403 W OAK ST STE 105
Second Line	:
City	:	EL DORADO
State	:	AR
Zip	:	71730-4573
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	403 W OAK ST STE 105
Second Line	:
City	:	EL DORADO
State	:	AR
Zip	:	71730-4573
Country	:	US
Telephone Number	:	870-639-8105
Fax Number	:

Authorized Official
Title or Position	:	MD
Name	:	VENKATA DURVASULA
Credential	:
Telephone Number	:	870-639-8105

Provider Enumeration Date	:	11/01/2021
Last Update Date	:	09/27/2022

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Directions to “JAIARKA LLC ” Practice Location

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