Provider Demographics
NPI:1639401946
Name:PAIN CLINIC OF NORTH ARKANSAS PLLC
Entity Type:Organization
Organization Name:PAIN CLINIC OF NORTH ARKANSAS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER/RECEPTIONIST
Authorized Official - Prefix:
Authorized Official - First Name:LISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-425-6212
Mailing Address - Street 1:# 17 MEDICAL PLAZA
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653
Mailing Address - Country:US
Mailing Address - Phone:870-425-6212
Mailing Address - Fax:
Practice Address - Street 1:# 17 MEDICAL PLAZA
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653
Practice Address - Country:US
Practice Address - Phone:870-425-6212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-11
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE4390207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty