Provider Demographics
NPI:1942321013
Name:ARKANSAS ALLERGY & ASTHMA CLINIC, PA
Entity Type:Organization
Organization Name:ARKANSAS ALLERGY & ASTHMA CLINIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TOMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-227-5210
Mailing Address - Street 1:2039 WEST MAIN STREET
Mailing Address - Street 2:SUITE C
Mailing Address - City:CABOT
Mailing Address - State:AR
Mailing Address - Zip Code:72023
Mailing Address - Country:US
Mailing Address - Phone:501-227-5210
Mailing Address - Fax:501-221-2443
Practice Address - Street 1:10310 W MARKHAM ST
Practice Address - Street 2:SUITE 222
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-2175
Practice Address - Country:US
Practice Address - Phone:501-227-5210
Practice Address - Fax:501-221-2443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR=========OtherFEDERAL TAX ID NUMBER