Provider Demographics
NPI:1639208382
Name:BEN T WILKINS MD INC
Entity Type:Organization
Organization Name:BEN T WILKINS MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BEN
Authorized Official - Middle Name:T
Authorized Official - Last Name:WILKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-279-0502
Mailing Address - Street 1:400 S MAIN ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-6848
Mailing Address - Country:US
Mailing Address - Phone:501-279-0502
Mailing Address - Fax:501-279-0506
Practice Address - Street 1:400 S MAIN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-6848
Practice Address - Country:US
Practice Address - Phone:501-279-0502
Practice Address - Fax:501-279-0506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE3747208000000X
ARA03713363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR150629002Medicaid
AR150629002Medicaid