Provider Demographics
NPI:1477569218
Name:ARKANSAS EPILEPSY PROGRAM
Entity Type:Organization
Organization Name:ARKANSAS EPILEPSY PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR ACCOUNTS REP
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHWERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-227-0705
Mailing Address - Street 1:2 LILE CT STE 100
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6241
Mailing Address - Country:US
Mailing Address - Phone:501-227-5061
Mailing Address - Fax:501-227-5234
Practice Address - Street 1:2 LILE CT
Practice Address - Street 2:S-100
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6221
Practice Address - Country:US
Practice Address - Phone:501-227-5061
Practice Address - Fax:501-227-5234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR-4085261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR070749035OtherHEALTHLINK
AR116520000OtherQUAL-CHOICE
AR125749002Medicaid
AR125749002Medicaid
AR5B545Medicare PIN
ARE96913Medicare UPIN