Provider Demographics
NPI:1669143491
Name:CENTRAL ARKANSAS VOLUNTEERS INMEDICINE
Entity type:Organization
Organization Name:CENTRAL ARKANSAS VOLUNTEERS INMEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-375-4400
Mailing Address - Street 1:201 E ROOSEVELT RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72206-2301
Mailing Address - Country:US
Mailing Address - Phone:501-375-4400
Mailing Address - Fax:501-375-4401
Practice Address - Street 1:201 E ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72206-2301
Practice Address - Country:US
Practice Address - Phone:501-375-4400
Practice Address - Fax:501-375-4401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-22
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty