Provider Demographics
NPI:1093986358
Name:SOUTH ARKANSAS HEMATOLOGY & ONCOLOGY CLINIC PA
Entity Type:Organization
Organization Name:SOUTH ARKANSAS HEMATOLOGY & ONCOLOGY CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:BILAL
Authorized Official - Last Name:MALIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-534-1188
Mailing Address - Street 1:1716 DOCTOR DR
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-6367
Mailing Address - Country:US
Mailing Address - Phone:870-534-1188
Mailing Address - Fax:870-534-0188
Practice Address - Street 1:1716 DOCTOR DR.
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-6367
Practice Address - Country:US
Practice Address - Phone:870-534-1188
Practice Address - Fax:870-534-0188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-14
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC8506207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR125074001Medicaid
AR5J360Medicare PIN
AR1137920001Medicare NSC
AR125074001Medicaid