Provider Demographics
NPI:1447797782
Name:SENIORWORKS PODIATRY LLC
Entity Type:Organization
Organization Name:SENIORWORKS PODIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MULLENAX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-821-4300
Mailing Address - Street 1:110 W COLONEL GLENN RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72210-5848
Mailing Address - Country:US
Mailing Address - Phone:501-821-4300
Mailing Address - Fax:
Practice Address - Street 1:110 W COLONEL GLENN RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72210-5848
Practice Address - Country:US
Practice Address - Phone:501-821-4300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-25
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004022363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty