Provider Demographics
NPI:1982637278
Name:SPECIALTY PRACTICE MANAGEMENT
Entity Type:Organization
Organization Name:SPECIALTY PRACTICE MANAGEMENT
Other - Org Name:NEA ANESTHESIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:KEYS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-227-0700
Mailing Address - Street 1:319 POINSETTA DR
Mailing Address - Street 2:P.O. BOX 55990
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-2251
Mailing Address - Country:US
Mailing Address - Phone:501-227-0700
Mailing Address - Fax:
Practice Address - Street 1:319 POINSETTA DR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-2251
Practice Address - Country:US
Practice Address - Phone:501-227-0700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5F392Medicare ID - Type Unspecified