Basic Information
| Provider Information | |||||||||
| NPI: | 1093137507 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ARKANSAS RHEUMATOLOGY CENTER, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 55630 | ||||||||
| Address2: | |||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722155630 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5012179382 | ||||||||
| FaxNumber: | 5012171692 | ||||||||
| Practice Location | |||||||||
| Address1: | 9101 KANIS RD | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722056456 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5012179382 | ||||||||
| FaxNumber: | 5012171692 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2014 | ||||||||
| LastUpdateDate: | 01/17/2014 | ||||||||
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| AuthorizedOfficialLastName: | YORK | ||||||||
| AuthorizedOfficialFirstName: | MARION | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 5012277688 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RR0500X | BL150264 | AR | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology |
ID Information
| ID | Type | State | Issuer | Description | BL150264 | 01 | AR | BUSINESS LICENSE | OTHER |