NORTHEAST ARKANSAS CLINIC, PA; NPI #1376517177

Contact Information

NORTHEAST ARKANSAS CLINIC, PA

1835 GRANT AVE.
JONESBORO, AR 72401

Phone: 870-934-5101
Fax: 870-932-3608
Website:

	Specialty	Taxonomy Code	Specialty Code	Provider Type
	Multi-Specialty	261QM1300X	70	Clinic or Group Practice

Indicates primary specialty

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NPI Profile & details for NORTHEAST ARKANSAS CLINIC, PA

NPI # 1376517177

LBN Legal business name NORTHEAST ARKANSAS CLINIC, PA

Authorized official ERROL DAVIS - (CFO)

Entity Organization

Organization subpart ¹ No

Enumeration date 02/16/2006

Last updated 04/05/2010 - About 16 years ago

Identifiers

Medicaid

139864002

¹ Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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