Provider Demographics
NPI:1164830576
Name:MEDEVOLVE
Entity Type:Organization
Organization Name:MEDEVOLVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING, AUDIT & COMPLAINCE
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:KAYE
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-801-8436
Mailing Address - Street 1:1115 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72201-2007
Mailing Address - Country:US
Mailing Address - Phone:501-687-9099
Mailing Address - Fax:501-687-9276
Practice Address - Street 1:1115 W 3RD ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72201-2007
Practice Address - Country:US
Practice Address - Phone:501-687-9099
Practice Address - Fax:501-687-9276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-29
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty