Provider Demographics
NPI:1346534047
Name:ARKANSAS FOOT & ANKLE CLINIC, PA
Entity Type:Organization
Organization Name:ARKANSAS FOOT & ANKLE CLINIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:THRASH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:870-535-4850
Mailing Address - Street 1:1801 W 40TH AVE
Mailing Address - Street 2:SUITE 4E
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-6940
Mailing Address - Country:US
Mailing Address - Phone:870-535-4850
Mailing Address - Fax:870-535-3558
Practice Address - Street 1:1801 W 40TH AVE
Practice Address - Street 2:SUITE 4E
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-6940
Practice Address - Country:US
Practice Address - Phone:870-535-4850
Practice Address - Fax:870-535-3558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-31
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR162213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR17389000000OtherQUAL CHOICE
AR2720022OtherUNITED HEALTHCARE
AR480021446OtherPALMETTO
AR5T328OtherBLUE CROSS AND BLUE SHIELD
AR4249008OtherAETNA
AR130021717Medicaid
ARU21697Medicare UPIN