Provider Demographics
NPI:1134121635
Name:PEDIATRIC ASSOCIATES OF JONESBORO, PLLC
Entity Type:Organization
Organization Name:PEDIATRIC ASSOCIATES OF JONESBORO, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMEBER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:REINHARD
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:870-972-5437
Mailing Address - Street 1:1150 E MATTHEWS AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-4314
Mailing Address - Country:US
Mailing Address - Phone:870-972-5437
Mailing Address - Fax:870-972-0104
Practice Address - Street 1:1150 E MATTHEWS AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-4314
Practice Address - Country:US
Practice Address - Phone:870-972-5437
Practice Address - Fax:870-972-0104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-15
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARMC-2201208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5C645OtherBLUE CROSS NUMBER