Provider Demographics
NPI:1437209491
Name:SMA MEDICINE & NEPHROLOGY CLINIC LLC
Entity Type:Organization
Organization Name:SMA MEDICINE & NEPHROLOGY CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOSES
Authorized Official - Middle Name:C
Authorized Official - Last Name:EJIOFOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-603-9277
Mailing Address - Street 1:1515 KANIS PARK DR STE B
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-4569
Mailing Address - Country:US
Mailing Address - Phone:501-603-9277
Mailing Address - Fax:501-603-9877
Practice Address - Street 1:1515 KANIS PARK DR STE B
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-4569
Practice Address - Country:US
Practice Address - Phone:501-603-9277
Practice Address - Fax:501-603-9877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center