Provider Demographics
NPI:1124208418
Name:ARKANSAS ARTHRITIS CLINIC, P.A.
Entity Type:Organization
Organization Name:ARKANSAS ARTHRITIS CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:KOVALESKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-666-6638
Mailing Address - Street 1:500 SOUTH UNIVERSITY AVE
Mailing Address - Street 2:SUITE 615
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-5308
Mailing Address - Country:US
Mailing Address - Phone:501-666-6638
Mailing Address - Fax:501-666-2535
Practice Address - Street 1:500 S UNIVERSITY AVE
Practice Address - Street 2:SUITE 615
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5302
Practice Address - Country:US
Practice Address - Phone:501-666-6638
Practice Address - Fax:501-666-2535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARN6231207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5C801Medicare PIN
AR52971C801Medicare UPIN