Provider Demographics
NPI:1659332849
Name:CENTRAL ARKANSAS PEDIATRICS, P.A.
Entity Type:Organization
Organization Name:CENTRAL ARKANSAS PEDIATRICS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:CRAIG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-328-0055
Mailing Address - Street 1:3010 FOUNTAIN DRIVE
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-3684
Mailing Address - Country:US
Mailing Address - Phone:501-328-0055
Mailing Address - Fax:501-328-2194
Practice Address - Street 1:3010 FOUNTAIN DRIVE
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-3684
Practice Address - Country:US
Practice Address - Phone:501-328-0055
Practice Address - Fax:501-328-2194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-29
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARMC-1956208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5C289OtherBLUE CROSS ID
AR139031002Medicaid