Provider Demographics
NPI:1538286554
Name:ADVANCED O&P TECHNIQUES
Entity Type:Organization
Organization Name:ADVANCED O&P TECHNIQUES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HAVIS
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:RHINEHART
Authorized Official - Suffix:
Authorized Official - Credentials:CP, BOC, CPED, FAA
Authorized Official - Phone:870-534-1900
Mailing Address - Street 1:2425 W 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-5051
Mailing Address - Country:US
Mailing Address - Phone:870-534-1900
Mailing Address - Fax:870-534-3187
Practice Address - Street 1:2425 W 28TH AVE
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-5051
Practice Address - Country:US
Practice Address - Phone:870-534-1900
Practice Address - Fax:870-534-3187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR49568OtherBCBS
AR49568OtherBCBS