Provider Demographics
NPI:1851494074
Name:NEUROLOGY CLINIC OF CENTRAL ARKANSAS
Entity Type:Organization
Organization Name:NEUROLOGY CLINIC OF CENTRAL ARKANSAS
Other - Org Name:SLEEP CLINIC OF ARKANSAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:R
Authorized Official - Last Name:GOZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-312-0070
Mailing Address - Street 1:11600 KANIS RD
Mailing Address - Street 2:STE 700
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-3727
Mailing Address - Country:US
Mailing Address - Phone:501-312-0070
Mailing Address - Fax:501-312-0072
Practice Address - Street 1:11600 KANIS RD
Practice Address - Street 2:STE 700
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-3727
Practice Address - Country:US
Practice Address - Phone:501-312-0070
Practice Address - Fax:501-312-0072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARMC1813261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
5C025Medicare PIN