Basic Information
| Provider Information | |||||||||
| NPI: | 1588809792 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTHEAST ARKANSAS CLINIC, P.A. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | NEA CLINIC-CENTER FOR SLEEP DISORDERS | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1960 | ||||||||
| Address2: | |||||||||
| City: | JONESBORO | ||||||||
| State: | AR | ||||||||
| PostalCode: | 724031960 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8709345140 | ||||||||
| FaxNumber: | 8709323608 | ||||||||
| Practice Location | |||||||||
| Address1: | 1118 WINDOVER RD | ||||||||
| Address2: | |||||||||
| City: | JONESBORO | ||||||||
| State: | AR | ||||||||
| PostalCode: | 724016038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8703364145 | ||||||||
| FaxNumber: | 8703364148 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/03/2008 | ||||||||
| LastUpdateDate: | 12/03/2008 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | KING | ||||||||
| AuthorizedOfficialFirstName: | DARRELL | ||||||||
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| AuthorizedOfficialTitleorPosition: | COO | ||||||||
| AuthorizedOfficialTelephone: | 8709345140 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | NORTHEAST ARKANSAS CLINIC, P.A. | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QS1200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Sleep Disorder Diagnostic |
No ID Information.