Provider Demographics
NPI:1073521175
Name:CENTRAL ARKANSAS GASTROENTEROLOGY CLINIC, PA
Entity Type:Organization
Organization Name:CENTRAL ARKANSAS GASTROENTEROLOGY CLINIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-664-7200
Mailing Address - Street 1:PO BOX 55073
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72215-5073
Mailing Address - Country:US
Mailing Address - Phone:501-664-7200
Mailing Address - Fax:501-664-7205
Practice Address - Street 1:212 NATURAL RESOURCES DR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-1573
Practice Address - Country:US
Practice Address - Phone:501-664-7200
Practice Address - Fax:501-664-7205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE3487207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5M425Medicare ID - Type Unspecified