Provider Demographics
NPI:1952503815
Name:ARKANSAS ASTHMA & LUNG CENTER, INC
Entity Type:Organization
Organization Name:ARKANSAS ASTHMA & LUNG CENTER, INC
Other - Org Name:ARKASSAS COMPREHENSIVE THERAPY
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:V
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-580-0458
Mailing Address - Street 1:4 BARBER CT
Mailing Address - Street 2:
Mailing Address - City:MAUMELLE
Mailing Address - State:AR
Mailing Address - Zip Code:72113-6491
Mailing Address - Country:US
Mailing Address - Phone:501-580-0458
Mailing Address - Fax:501-565-5701
Practice Address - Street 1:4501 N HIGHWAY 7
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS VILLAGE
Practice Address - State:AR
Practice Address - Zip Code:71909-9799
Practice Address - Country:US
Practice Address - Phone:501-984-5800
Practice Address - Fax:501-984-5809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2265261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)