Provider Demographics
NPI:1851576185
Name:NIMMO PSYCHIATRIC SERVICES, INC.
Entity Type:Organization
Organization Name:NIMMO PSYCHIATRIC SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:T
Authorized Official - Last Name:NIMMO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-765-9272
Mailing Address - Street 1:14109 LONGTREE DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72212-1912
Mailing Address - Country:US
Mailing Address - Phone:501-765-9272
Mailing Address - Fax:
Practice Address - Street 1:801 SCOTT ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72201-4613
Practice Address - Country:US
Practice Address - Phone:501-221-7238
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-06
Last Update Date:2008-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE31772084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty