Provider Demographics
NPI:1972535441
Name:ARCHIE HEARNE MD PA
Entity Type:Organization
Organization Name:ARCHIE HEARNE MD PA
Other - Org Name:HEARNE FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FAMILY PRACTICE / PED'S
Authorized Official - Prefix:
Authorized Official - First Name:ARCHIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HEARNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-224-2800
Mailing Address - Street 1:1001 WRIGHT AVE
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72206-1062
Mailing Address - Country:US
Mailing Address - Phone:501-224-2800
Mailing Address - Fax:501-224-2829
Practice Address - Street 1:1001 WRIGHT AVE
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72206-1062
Practice Address - Country:US
Practice Address - Phone:501-224-2800
Practice Address - Fax:501-224-2829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARN-6227302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR770216502Medicaid
AR138830002Medicaid