Provider Demographics
NPI:1912032657
Name:ARKANSAS UROLOGY CLINIC, LTD
Entity Type:Organization
Organization Name:ARKANSAS UROLOGY CLINIC, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MELVIN
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-932-8674
Mailing Address - Street 1:1150 E MATTHEWS AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-4314
Mailing Address - Country:US
Mailing Address - Phone:870-932-8674
Mailing Address - Fax:870-932-2005
Practice Address - Street 1:1150 E MATTHEWS AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-4314
Practice Address - Country:US
Practice Address - Phone:870-932-8674
Practice Address - Fax:870-932-2005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARMC0918208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5C080Medicare ID - Type Unspecified