Provider Demographics
NPI:1558383414
Name:NORTH CENTRAL I V & RESPIRATORY SPECIALISTS LLC
Entity Type:Organization
Organization Name:NORTH CENTRAL I V & RESPIRATORY SPECIALISTS LLC
Other - Org Name:NORTH CENTRAL I V & RESPIRATORY SPECIALISTS LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:DARR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-932-0150
Mailing Address - Street 1:202 E WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-3102
Mailing Address - Country:US
Mailing Address - Phone:870-932-0150
Mailing Address - Fax:
Practice Address - Street 1:202 E WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-3102
Practice Address - Country:US
Practice Address - Phone:870-932-0150
Practice Address - Fax:870-932-0870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR203703336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR150355407Medicaid
AR152028716Medicaid
0421901OtherNCPDP PROVIDER IDENTIFICATION NUMBER
AR154617733Medicaid
4903850001Medicare NSC