Provider Demographics
NPI:1881848257
Name:ARKANSAS CENTRAL PRIMARY CARE PLLC
Entity Type:Organization
Organization Name:ARKANSAS CENTRAL PRIMARY CARE PLLC
Other - Org Name:CABOT MEDICAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JUDI
Authorized Official - Middle Name:
Authorized Official - Last Name:HARVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-843-4555
Mailing Address - Street 1:2037 W MAIN ST
Mailing Address - Street 2:P.O. BOX 1325
Mailing Address - City:CABOT
Mailing Address - State:AR
Mailing Address - Zip Code:72023-7479
Mailing Address - Country:US
Mailing Address - Phone:501-843-4555
Mailing Address - Fax:501-743-1550
Practice Address - Street 1:2037 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CABOT
Practice Address - State:AR
Practice Address - Zip Code:72023-7479
Practice Address - Country:US
Practice Address - Phone:501-843-4555
Practice Address - Fax:501-743-1550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-11
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty