Basic Information
| Provider Information | |||||||||
| NPI: | 1700905296 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | THE DOCTOR'S OFFICE OF MARKED TREE | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| OtherOrganizationName: | KIMITAKA SAITO, MD | ||||||||
| OtherOrganizationType: | 5 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 616 | ||||||||
| Address2: | |||||||||
| City: | MARKED TREE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 723650616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8703584355 | ||||||||
| FaxNumber: | 8703584357 | ||||||||
| Practice Location | |||||||||
| Address1: | 202 NEWSOME DR | ||||||||
| Address2: | |||||||||
| City: | MARKED TREE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 723652021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8703584355 | ||||||||
| FaxNumber: | 8703584357 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2007 | ||||||||
| LastUpdateDate: | 07/02/2009 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | SAITO | ||||||||
| AuthorizedOfficialFirstName: | KIMITAKA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OWNER PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 8703584355 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | R2736 | AR | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 142472002 | 05 | AR | MEDICAID |