National Provider Identifier Database

NORTHEAST ARKANSAS CLINIC PA
Multi-Specialty


Contact Information

NORTHEAST ARKANSAS CLINIC, PA
1835 GRANT AVE.
JONESBORO, AR72401
Phone: 870-934-5101
Fax: 870-932-3608
Website:
Specialty Taxonomy Code
* Multi-Specialty 261QM1300X

* Indicates primary specialty

NPI Profile & details for NORTHEAST ARKANSAS CLINIC, PA

NPI Number 1376517177
Legal business name
LBN
NORTHEAST ARKANSAS CLINIC, PA
Authorized official ERROL DAVIS - (CFO)
Entity Organization
Organization subpart No
Enumeration date 02/16/2006
Last updated 04/05/2010 - About 16 years ago
Sole proprietor1 Not specified
Identifiers
  • AR Medicaid: 139864002

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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