Provider Demographics
NPI:1043455256
Name:ADVANCED O & P TECHNIQUES, PA
Entity Type:Organization
Organization Name:ADVANCED O & P TECHNIQUES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HAVIS
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:RINEHART
Authorized Official - Suffix:
Authorized Official - Credentials:CPO,BOC,CPED,FAAOP
Authorized Official - Phone:870-534-1900
Mailing Address - Street 1:2425 W 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-5051
Mailing Address - Country:US
Mailing Address - Phone:870-534-1900
Mailing Address - Fax:870-534-3187
Practice Address - Street 1:705 DONAGHEY AVE
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-5107
Practice Address - Country:US
Practice Address - Phone:501-548-6288
Practice Address - Fax:501-513-1890
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCED O & P TECHNIQUES, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-03
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR261Q00000X261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR134833716Medicaid
AR49568OtherBCBS
AR134833716Medicaid
AR49568OtherBCBS