Provider Demographics
NPI:1790718369
Name:DR. KUMAR'S MEDICAL CLINIC PA
Entity Type:Organization
Organization Name:DR. KUMAR'S MEDICAL CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUDHIR
Authorized Official - Middle Name:
Authorized Official - Last Name:KUMAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-633-5016
Mailing Address - Street 1:1801 LINDAUER RD
Mailing Address - Street 2:
Mailing Address - City:FORREST CITY
Mailing Address - State:AR
Mailing Address - Zip Code:72335-2407
Mailing Address - Country:US
Mailing Address - Phone:870-633-5016
Mailing Address - Fax:870-633-6309
Practice Address - Street 1:1801 LINDAUER RD
Practice Address - Street 2:
Practice Address - City:FORREST CITY
Practice Address - State:AR
Practice Address - Zip Code:72335-2407
Practice Address - Country:US
Practice Address - Phone:870-633-5016
Practice Address - Fax:870-633-6309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR4521174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5B598Medicare ID - Type Unspecified