Provider Demographics
NPI:1255771531
Name:ARKANSAS
Entity type:Organization
Organization Name:ARKANSAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANA
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:FOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-690-1328
Mailing Address - Street 1:2011 HILLSBOROUGH LN
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72212-3730
Mailing Address - Country:US
Mailing Address - Phone:501-690-1328
Mailing Address - Fax:501-562-0327
Practice Address - Street 1:412 W 6TH AVE
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71601-4136
Practice Address - Country:US
Practice Address - Phone:501-690-1328
Practice Address - Fax:501-562-0327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-01
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization