Provider Demographics
NPI:1851352991
Name:NORTHEAST ARKANSAS CLINIC, P.A.
Entity Type:Organization
Organization Name:NORTHEAST ARKANSAS CLINIC, P.A.
Other - Org Name:NEA CLINIC DIALYSIS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR CENTRAL BILLING OFFICE
Authorized Official - Prefix:
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-934-5803
Mailing Address - Street 1:3005 MIDDLEFIELD DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-7438
Mailing Address - Country:US
Mailing Address - Phone:870-934-5705
Mailing Address - Fax:870-972-1695
Practice Address - Street 1:3005 MIDDLEFIELD DR
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-7438
Practice Address - Country:US
Practice Address - Phone:870-934-5705
Practice Address - Fax:870-972-1695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-29
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARMC-2122261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR04-2577Medicare ID - Type Unspecified