Provider Demographics
NPI:1508064007
Name:SPINE CARE OF ARKANSAS P.L.L.C
Entity Type:Organization
Organization Name:SPINE CARE OF ARKANSAS P.L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURACE REP
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:CLAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-975-5005
Mailing Address - Street 1:PO BOX 34113
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72203-4113
Mailing Address - Country:US
Mailing Address - Phone:501-975-5005
Mailing Address - Fax:501-975-5008
Practice Address - Street 1:14918 CANTRELL RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72223-4248
Practice Address - Country:US
Practice Address - Phone:501-975-5005
Practice Address - Fax:501-975-5008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-05
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE2047174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5C982OtherMCR & BCBS PAYOR #
AR136646001Medicaid
AR136646001Medicaid
AR5C982OtherMCR & BCBS PAYOR #