Provider Demographics
NPI:1326149493
Name:ARKANSAS OCCUPATIONAL MEDICINE SERVICES PA
Entity Type:Organization
Organization Name:ARKANSAS OCCUPATIONAL MEDICINE SERVICES PA
Other - Org Name:ARKANSAS OCCUPATIONAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MOFFITT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-725-3043
Mailing Address - Street 1:4001 WAGON WHEEL RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-0137
Mailing Address - Country:US
Mailing Address - Phone:479-725-3000
Mailing Address - Fax:479-725-3098
Practice Address - Street 1:4001 WAGON WHEEL RD
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-0137
Practice Address - Country:US
Practice Address - Phone:479-725-3000
Practice Address - Fax:479-725-3098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-5918174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARPT1914OtherJON LEE, PT
ARH49816Medicare UPIN
ARP78622Medicare UPIN
ARPT1914OtherJON LEE, PT
ARH10497Medicare UPIN