Provider Demographics
NPI:1093720443
Name:ARKANSAS UROLOGY, P.A.
Entity Type:Organization
Organization Name:ARKANSAS UROLOGY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BELFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-219-8900
Mailing Address - Street 1:1300 CENTERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-4349
Mailing Address - Country:US
Mailing Address - Phone:501-219-8900
Mailing Address - Fax:501-537-1875
Practice Address - Street 1:1300 CENTERVIEW DR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-4349
Practice Address - Country:US
Practice Address - Phone:501-219-8900
Practice Address - Fax:501-537-1875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARMC-1638208800000X
AR1117630001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR128541002Medicaid
ARAR20971OtherCOMMUNITY/RETAIL PHARMACY LICENSE
AR5B757Medicare ID - Type Unspecified