Provider Demographics
NPI:1255799656
Name:CHRISTOPHER K MOCEK MD PA
Entity type:Organization
Organization Name:CHRISTOPHER K MOCEK MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:K
Authorized Official - Last Name:MOCEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-224-4001
Mailing Address - Street 1:9101 KANIS RD, STE 400
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6456
Mailing Address - Country:US
Mailing Address - Phone:501-224-4001
Mailing Address - Fax:501-224-4003
Practice Address - Street 1:9101 KANIS RD STE 400
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6450
Practice Address - Country:US
Practice Address - Phone:501-224-4001
Practice Address - Fax:501-224-4003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-01
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR207L00000X, 363L00000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR131987001Medicaid
G21943Medicare UPIN
720000022Medicare Oscar/Certification
5K677Medicare PIN