Provider Demographics
NPI:1003274358
Name:BOX, DEMETRI (MHPP)
Entity Type:Individual
Prefix:
First Name:DEMETRI
Middle Name:
Last Name:BOX
Suffix:
Gender:M
Credentials:MHPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 S POPLAR ST STE A
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-6000
Mailing Address - Country:US
Mailing Address - Phone:501-249-9220
Mailing Address - Fax:501-279-9450
Practice Address - Street 1:403 S POPLAR ST STE A
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-6000
Practice Address - Country:US
Practice Address - Phone:501-249-9220
Practice Address - Fax:501-279-9450
Is Sole Proprietor?:No
Enumeration Date:2016-02-02
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator