Provider Demographics
NPI:1982679916
Name:ARKANSAS NEPHROLOGY SERVICES, LTD.
Entity Type:Organization
Organization Name:ARKANSAS NEPHROLOGY SERVICES, LTD.
Other - Org Name:DEGRAY KIDNEY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:LIGON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-624-6000
Mailing Address - Street 1:115 WRIGHTS ST
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-6240
Mailing Address - Country:US
Mailing Address - Phone:501-624-6000
Mailing Address - Fax:501-321-0710
Practice Address - Street 1:312 PROFESSIONAL PARK DR
Practice Address - Street 2:SUITE H
Practice Address - City:ARKADELPHIA
Practice Address - State:AR
Practice Address - Zip Code:71923-5315
Practice Address - Country:US
Practice Address - Phone:870-246-3021
Practice Address - Fax:870-245-3766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-22
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR112936134Medicaid
AR112936134Medicaid