Provider Demographics
NPI:1003020868
Name:ANDREW J POWELL MD, PLLC
Entity Type:Organization
Organization Name:ANDREW J POWELL MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACI
Authorized Official - Middle Name:G
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-605-1144
Mailing Address - Street 1:PO BOX 500
Mailing Address - Street 2:
Mailing Address - City:CABOT
Mailing Address - State:AR
Mailing Address - Zip Code:72023-0500
Mailing Address - Country:US
Mailing Address - Phone:501-605-1144
Mailing Address - Fax:501-605-1144
Practice Address - Street 1:25 HICKORY BEND DR
Practice Address - Street 2:
Practice Address - City:CABOT
Practice Address - State:AR
Practice Address - Zip Code:72023-8183
Practice Address - Country:US
Practice Address - Phone:501-605-1144
Practice Address - Fax:501-605-1144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARMC-23912084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5F082Medicare ID - Type UnspecifiedGROUP ID NUMBER
ARC67814Medicare UPIN