Provider Demographics
NPI:1073917274
Name:ARKANSAS PEDIATRIC CLINIC, PLLC
Entity Type:Organization
Organization Name:ARKANSAS PEDIATRIC CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PARSONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-664-4117
Mailing Address - Street 1:16115 SAINT VINCENT WAY STE 320
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-3000
Mailing Address - Country:US
Mailing Address - Phone:501-664-4117
Mailing Address - Fax:501-664-1137
Practice Address - Street 1:16115 SAINT VINCENT WAY STE 320
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72223-3000
Practice Address - Country:US
Practice Address - Phone:501-664-4117
Practice Address - Fax:501-664-1137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-17
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR204313002Medicaid
AR213058002Medicaid
AR148500002Medicaid
AR226133002Medicaid