Provider Demographics
NPI:1609892330
Name:GENERAL ORTHOPAEDICS AND ADULT SPINE
Entity Type:Organization
Organization Name:GENERAL ORTHOPAEDICS AND ADULT SPINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR PHYSICIAN SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BELFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-278-3154
Mailing Address - Street 1:904 AUTUMN RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-3702
Mailing Address - Country:US
Mailing Address - Phone:501-278-3154
Mailing Address - Fax:501-278-3455
Practice Address - Street 1:1120 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-7319
Practice Address - Country:US
Practice Address - Phone:501-278-3154
Practice Address - Fax:501-278-3455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5F453Medicare PIN