Provider Demographics
NPI:1740239417
Name:NEUROSURGICAL ASSOCIATES OF NE AR
Entity Type:Organization
Organization Name:NEUROSURGICAL ASSOCIATES OF NE AR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:TONYMON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-972-1112
Mailing Address - Street 1:PO BOX 9371
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72403-9371
Mailing Address - Country:US
Mailing Address - Phone:870-972-1112
Mailing Address - Fax:870-933-8575
Practice Address - Street 1:1118 WINDOVER RD
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-6038
Practice Address - Country:US
Practice Address - Phone:870-972-1112
Practice Address - Fax:870-933-8575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR57939Medicare ID - Type Unspecified