Basic Information
Provider Information
NPI: 1366006322
EntityType: 2
ReplacementNPI:  
OrganizationName: ARCARE
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 497
Address2:  
City: AUGUSTA
State: AR
PostalCode: 720060497
CountryCode: US
TelephoneNumber: 8703472534
FaxNumber: 8703471235
Practice Location
Address1: 900B S WALTON BLVD STE 21
Address2:  
City: BENTONVILLE
State: AR
PostalCode: 727126362
CountryCode: US
TelephoneNumber: 4797154745
FaxNumber: 4792546868
Other Information
ProviderEnumerationDate: 04/25/2019
LastUpdateDate: 01/20/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: COLLIER
AuthorizedOfficialFirstName: STEVEN
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: CEO
AuthorizedOfficialTelephone: 8703473300
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: MD
NPICertificationDate: 01/20/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
261QP2300X  Y Ambulatory Health Care FacilitiesClinic/CenterPrimary Care

No ID Information.


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