Provider Demographics
NPI:1851737506
Name:ARK-LA-TEX SPINE APMC
Entity Type:Organization
Organization Name:ARK-LA-TEX SPINE APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFEREY
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-487-2248
Mailing Address - Street 1:PO BOX 837
Mailing Address - Street 2:
Mailing Address - City:HOWE
Mailing Address - State:TX
Mailing Address - Zip Code:75459-0837
Mailing Address - Country:US
Mailing Address - Phone:903-487-2248
Mailing Address - Fax:903-487-2306
Practice Address - Street 1:8660 FERN AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5649
Practice Address - Country:US
Practice Address - Phone:903-487-2248
Practice Address - Fax:903-487-2306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-21
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD020437208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty