Provider Demographics
NPI:1952485542
Name:CENTRAL ARKANSAS PAIN CENTER PA
Entity Type:Organization
Organization Name:CENTRAL ARKANSAS PAIN CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:L
Authorized Official - Last Name:BOOS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:501-262-1000
Mailing Address - Street 1:307 CARPENTER DAM RD STE F
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71901-8282
Mailing Address - Country:US
Mailing Address - Phone:501-262-1000
Mailing Address - Fax:501-262-1011
Practice Address - Street 1:307 CARPENTER DAM RD STE F
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-8282
Practice Address - Country:US
Practice Address - Phone:501-262-1000
Practice Address - Fax:501-262-1011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARN8196208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR90363000000OtherQUALCHOICE
AR612385300OtherDEPT OF LABOR
ARDF603OtherRAILROAD MEDICARE
AR375580OtherHEALTHLINK
AR163020002Medicaid
AR5F679OtherBLUE CROSS
AR612385300OtherDEPT OF LABOR
AR90363000000OtherQUALCHOICE