Provider Demographics
NPI:1417164559
Name:NEUROLOGY AND SLEEP DISORDER CENTER OF SOUTH ARKANSAS
Entity Type:Organization
Organization Name:NEUROLOGY AND SLEEP DISORDER CENTER OF SOUTH ARKANSAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHAILESH
Authorized Official - Middle Name:C
Authorized Official - Last Name:VORA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-863-7399
Mailing Address - Street 1:300 THOMPSON AVE
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-4569
Mailing Address - Country:US
Mailing Address - Phone:870-863-7399
Mailing Address - Fax:870-863-7292
Practice Address - Street 1:300 THOMPSON AVE
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-4569
Practice Address - Country:US
Practice Address - Phone:870-863-7399
Practice Address - Fax:870-863-7292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR3612174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5F822OtherBLUE CROSS BLUE SHIELD