Provider Demographics
NPI:1295958346
Name:JEFFREY P KIRSCH MD PA
Entity type:Organization
Organization Name:JEFFREY P KIRSCH MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MD OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:PHILLIP
Authorized Official - Last Name:KIRSCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-932-7600
Mailing Address - Street 1:2425 DAVE WARD DR STE 101
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-8679
Mailing Address - Country:US
Mailing Address - Phone:501-932-7600
Mailing Address - Fax:501-932-7603
Practice Address - Street 1:2425 DAVE WARD DR STE 101
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-8679
Practice Address - Country:US
Practice Address - Phone:501-932-7600
Practice Address - Fax:501-932-7603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE2703174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR145207002Medicaid
AR5L686Medicare ID - Type Unspecified
AR145207002Medicaid