Provider Demographics
NPI:1124032560
Name:NEUROLOGY CLINIC OF SOUTH ARKANSAS,PA
Entity Type:Organization
Organization Name:NEUROLOGY CLINIC OF SOUTH ARKANSAS,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GHULAM
Authorized Official - Middle Name:
Authorized Official - Last Name:KHALEEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-863-3373
Mailing Address - Street 1:105 FRANKIE LN
Mailing Address - Street 2:
Mailing Address - City:WHITE HALL
Mailing Address - State:AR
Mailing Address - Zip Code:71605-3027
Mailing Address - Country:US
Mailing Address - Phone:870-882-5184
Mailing Address - Fax:
Practice Address - Street 1:105 FRANKIE LN
Practice Address - Street 2:
Practice Address - City:WHITE HALL
Practice Address - State:AR
Practice Address - Zip Code:71605-3027
Practice Address - Country:US
Practice Address - Phone:870-882-5184
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5F365OtherBLUE CROSS
AR158303002Medicaid
AR158303002Medicaid
AR5F365OtherBLUE CROSS