Provider Demographics
NPI:1497736508
Name:NES ARKANSAS, INC.
Entity Type:Organization
Organization Name:NES ARKANSAS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-377-8721
Mailing Address - Street 1:PO BOX 403234
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-3234
Mailing Address - Country:US
Mailing Address - Phone:800-377-8721
Mailing Address - Fax:304-523-2241
Practice Address - Street 1:EAST MAIN & SOUTH 20TH STREET
Practice Address - Street 2:
Practice Address - City:VAN BUREN
Practice Address - State:AR
Practice Address - Zip Code:72956
Practice Address - Country:US
Practice Address - Phone:479-474-3401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5C809OtherGROUP BCBS NUMBER
AR5C809Medicare ID - Type UnspecifiedGROUP NUMBER