Provider Demographics
NPI:1346204161
Name:PKH ENTERPRISES, INC.
Entity Type:Organization
Organization Name:PKH ENTERPRISES, INC.
Other - Org Name:HOT SPRINGS SPORTS MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MILROY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-767-0808
Mailing Address - Street 1:2278 ALBERT PIKE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-4003
Mailing Address - Country:US
Mailing Address - Phone:501-767-0808
Mailing Address - Fax:501-767-0832
Practice Address - Street 1:2278 ALBERT PIKE RD
Practice Address - Street 2:SUITE B
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-4003
Practice Address - Country:US
Practice Address - Phone:501-767-0808
Practice Address - Fax:501-767-0832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT-2410174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5W535Medicare ID - Type UnspecifiedJON WILKERSON'S MEDICARE
AR5C350Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER