Provider Demographics
NPI:1174858831
Name:PULASKI CARE INC
Entity Type:Organization
Organization Name:PULASKI CARE INC
Other - Org Name:MEDICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:K
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-619-1657
Mailing Address - Street 1:4912B FOUNTAIN AVE
Mailing Address - Street 2:SUITE 40
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90029-1502
Mailing Address - Country:US
Mailing Address - Phone:870-619-1657
Mailing Address - Fax:501-421-6845
Practice Address - Street 1:4201 S MULBERRY ST
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-7016
Practice Address - Country:US
Practice Address - Phone:870-619-1657
Practice Address - Fax:501-421-6845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-13
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR04D0465285291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory