Provider Demographics
NPI:1568975761
Name:REEVES MEDICAL ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:REEVES MEDICAL ASSOCIATES, PLLC
Other - Org Name:REEVESMED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:R
Authorized Official - Last Name:REEVES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:479-224-1565
Mailing Address - Street 1:1415 E CENTERTON BLVD
Mailing Address - Street 2:
Mailing Address - City:CENTERTON
Mailing Address - State:AR
Mailing Address - Zip Code:72719-7050
Mailing Address - Country:US
Mailing Address - Phone:479-224-1565
Mailing Address - Fax:844-758-8644
Practice Address - Street 1:1415 E CENTERTON BLVD
Practice Address - Street 2:
Practice Address - City:CENTERTON
Practice Address - State:AR
Practice Address - Zip Code:72719
Practice Address - Country:US
Practice Address - Phone:479-224-1565
Practice Address - Fax:844-758-8644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-09
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR182936003Medicaid