Provider Demographics
NPI:1255310066
Name:ARKANSAS COUNTY ANESTHESIA AND PAIN MANAGEMENT, P.A.
Entity Type:Organization
Organization Name:ARKANSAS COUNTY ANESTHESIA AND PAIN MANAGEMENT, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:PAVLOVNA
Authorized Official - Last Name:BLAKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-674-6402
Mailing Address - Street 1:PO BOX 115
Mailing Address - Street 2:
Mailing Address - City:STUTTGART
Mailing Address - State:AR
Mailing Address - Zip Code:72160-0115
Mailing Address - Country:US
Mailing Address - Phone:870-674-6402
Mailing Address - Fax:
Practice Address - Street 1:1703 N BUERKLE ST
Practice Address - Street 2:SUITE 8
Practice Address - City:STUTTGART
Practice Address - State:AR
Practice Address - Zip Code:72160-3153
Practice Address - Country:US
Practice Address - Phone:870-674-6402
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
5F387Medicare ID - Type UnspecifiedGROUP IDENTIFICATION