Provider Demographics
NPI:1821018417
Name:CENTRAL ARKANSAS HEMATOLOGY AND ONCOLOGY CLINIC, PA
Entity Type:Organization
Organization Name:CENTRAL ARKANSAS HEMATOLOGY AND ONCOLOGY CLINIC, PA
Other - Org Name:GENESIS CANCER CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-624-7700
Mailing Address - Street 1:133 HARMONY PARK CIRCLE
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913
Mailing Address - Country:US
Mailing Address - Phone:501-624-7700
Mailing Address - Fax:
Practice Address - Street 1:133 HARMONY PARK CIRCLE
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913
Practice Address - Country:US
Practice Address - Phone:501-624-7700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARMC-1130261QX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR114519002Medicaid
CS5240OtherRAILROAD MEDICARE
AR0752190001Medicare NSC
AR57731Medicare PIN