Provider Demographics
NPI:1508531146
Name:INFINITY HEALTH OF ARKANSAS LLC
Entity Type:Organization
Organization Name:INFINITY HEALTH OF ARKANSAS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:TABOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-247-5454
Mailing Address - Street 1:25255 HIGHWAY 5 STE K
Mailing Address - Street 2:
Mailing Address - City:LONSDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72087-9102
Mailing Address - Country:US
Mailing Address - Phone:501-476-7171
Mailing Address - Fax:
Practice Address - Street 1:25255 HIGHWAY 5 STE K
Practice Address - Street 2:
Practice Address - City:LONSDALE
Practice Address - State:AR
Practice Address - Zip Code:72087-9102
Practice Address - Country:US
Practice Address - Phone:501-476-7171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-16
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center