Provider Demographics
NPI:1245416007
Name:MEDBASICS ARKANSAS LLC
Entity Type:Organization
Organization Name:MEDBASICS ARKANSAS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JODI
Authorized Official - Middle Name:
Authorized Official - Last Name:KRUSELY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-838-3832
Mailing Address - Street 1:PO BOX 671621
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-1621
Mailing Address - Country:US
Mailing Address - Phone:972-580-7700
Mailing Address - Fax:972-580-7715
Practice Address - Street 1:105 N RODNEY PARHAM RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-2421
Practice Address - Country:US
Practice Address - Phone:501-221-1831
Practice Address - Fax:501-221-1841
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDBASICS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-10
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care