Provider Demographics
NPI: | 1497023147 |
---|---|
Name: | REEVES SPINE AND ORTHOPEDIC,LLC |
Entity Type: | Organization |
Organization Name: | REEVES SPINE AND ORTHOPEDIC,LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | CHRIS |
Authorized Official - Middle Name: | RYAN |
Authorized Official - Last Name: | REEVES |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DO |
Authorized Official - Phone: | 870-741-8289 |
Mailing Address - Street 1: | 224 W. ERIE |
Mailing Address - Street 2: | |
Mailing Address - City: | HARRISON |
Mailing Address - State: | AR |
Mailing Address - Zip Code: | 72601 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 870-741-8289 |
Mailing Address - Fax: | 870-741-0308 |
Practice Address - Street 1: | 224 W. ERIE |
Practice Address - Street 2: | |
Practice Address - City: | HARRISON |
Practice Address - State: | AR |
Practice Address - Zip Code: | 72601 |
Practice Address - Country: | US |
Practice Address - Phone: | 870-741-8289 |
Practice Address - Fax: | 870-741-0308 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2011-12-09 |
Last Update Date: | 2011-12-09 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
AR | E7280 | 207X00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Single Specialty |