Provider Demographics
NPI:1366450421
Name:REHAB AND PAIN MANAGMENT CLINIC INC.
Entity Type:Organization
Organization Name:REHAB AND PAIN MANAGMENT CLINIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VIRENDAR
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:VERMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-536-6700
Mailing Address - Street 1:P.O. BOX 1191
Mailing Address - Street 2:REHAB AND PAIN MANAGEMENT CLINIC
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72403
Mailing Address - Country:US
Mailing Address - Phone:870-275-6010
Mailing Address - Fax:870-203-0945
Practice Address - Street 1:1201 FLEMING AVE
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-4311
Practice Address - Country:US
Practice Address - Phone:870-275-6010
Practice Address - Fax:870-203-0945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2081P2900X
ARR-4265261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR120955001Medicaid
AR120955001Medicaid
AR5B185Medicare ID - Type UnspecifiedCLINIC