Provider Demographics
NPI:1275575193
Name:ARKANSAS ASTHMA & LUNG CENTERS INC
Entity Type:Organization
Organization Name:ARKANSAS ASTHMA & LUNG CENTERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:V
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-580-0458
Mailing Address - Street 1:8624C W MARKHAM ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-2313
Mailing Address - Country:US
Mailing Address - Phone:501-580-0458
Mailing Address - Fax:501-372-2595
Practice Address - Street 1:4 BARBER CT
Practice Address - Street 2:
Practice Address - City:MAUMELLE
Practice Address - State:AR
Practice Address - Zip Code:72113-6491
Practice Address - Country:US
Practice Address - Phone:501-580-0458
Practice Address - Fax:501-372-2595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR044504225B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225B00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPulmonary Function TechnologistGroup - Multi-Specialty