Provider Demographics
NPI:1760242440
Name:TBD HEALTH ENTERPRISES OF ARKANSAS PLLC
Entity Type:Organization
Organization Name:TBD HEALTH ENTERPRISES OF ARKANSAS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:B
Authorized Official - Last Name:DE MIRANDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-434-3600
Mailing Address - Street 1:2707 MARKET TRCE
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72908-8694
Mailing Address - Country:US
Mailing Address - Phone:479-434-3600
Mailing Address - Fax:
Practice Address - Street 1:2707 MARKET TRCE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72908-8694
Practice Address - Country:US
Practice Address - Phone:479-434-3600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty