Provider Demographics
NPI:1356654164
Name:LITTLE ROCK PAIN & REHABILITATION CONSULTANTS, PLLC
Entity type:Organization
Organization Name:LITTLE ROCK PAIN & REHABILITATION CONSULTANTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:K
Authorized Official - Last Name:PONDEXTER HUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-225-6900
Mailing Address - Street 1:500 S UNIVERSITY AVE STE 318
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-5305
Mailing Address - Country:US
Mailing Address - Phone:501-225-6900
Mailing Address - Fax:501-225-6911
Practice Address - Street 1:500 S UNIVERSITY AVE STE 318
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5305
Practice Address - Country:US
Practice Address - Phone:501-225-6900
Practice Address - Fax:501-225-6911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-21
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE45222081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5G534OtherMEDICARE PTAN
AR5N395OtherMEDICARE ID
ARI44789Medicare UPIN