Basic Information
| Provider Information | |||||||||
| NPI: | 1942321013 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ARKANSAS ALLERGY & ASTHMA CLINIC, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2039 WEST MAIN STREET | ||||||||
| Address2: | SUITE C | ||||||||
| City: | CABOT | ||||||||
| State: | AR | ||||||||
| PostalCode: | 72023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5012275210 | ||||||||
| FaxNumber: | 5012212443 | ||||||||
| Practice Location | |||||||||
| Address1: | 10310 W MARKHAM ST | ||||||||
| Address2: | SUITE 222 | ||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722052175 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5012275210 | ||||||||
| FaxNumber: | 5012212443 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | JOHNSON | ||||||||
| AuthorizedOfficialFirstName: | TOMMY | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 5012275210 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207K00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Allergy & Immunology |
No ID Information.