Provider Demographics
NPI:1861653776
Name:CAROL W. CHAPPELL, M.D.
Entity Type:Organization
Organization Name:CAROL W. CHAPPELL, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FLORA
Authorized Official - Middle Name:JEANNE
Authorized Official - Last Name:COLGLAZIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-661-1123
Mailing Address - Street 1:5 SAINT VINCENT CIR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-5412
Mailing Address - Country:US
Mailing Address - Phone:501-661-1123
Mailing Address - Fax:501-661-0046
Practice Address - Street 1:5 SAINT VINCENT CIR
Practice Address - Street 2:SUITE 200
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5412
Practice Address - Country:US
Practice Address - Phone:501-661-1123
Practice Address - Fax:501-661-0046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-23
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC4804207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR50981OtherBLUE CROSS &BLUE SHIELD
180002066OtherRAILROAD MEDICARE
14216000000OtherQUALCHOICE OF ARKANSAS
50981Medicare PIN
14216000000OtherQUALCHOICE OF ARKANSAS