Provider Demographics
NPI:1013274364
Name:SERVANT HEALTHCARE, PA
Entity Type:Organization
Organization Name:SERVANT HEALTHCARE, PA
Other - Org Name:APEX MEN'S HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:WARFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-920-2252
Mailing Address - Street 1:10700 N RODNEY PARHAM ROAD
Mailing Address - Street 2:STE C-10A
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72212
Mailing Address - Country:US
Mailing Address - Phone:501-246-7274
Mailing Address - Fax:501-421-4161
Practice Address - Street 1:10700 N RODNEY PARHAM ROAD
Practice Address - Street 2:STE C-10A
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72212
Practice Address - Country:US
Practice Address - Phone:501-246-7274
Practice Address - Fax:501-421-4161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-11
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARBL00123175261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5GB23OtherMEDICARE GROUP PTAN