Provider Demographics
NPI:1669619987
Name:CENTRAL ARKANSAS VASCULAR ASSOCIATES PLLC
Entity type:Organization
Organization Name:CENTRAL ARKANSAS VASCULAR ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:LANE
Authorized Official - Last Name:ALBERTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-219-1970
Mailing Address - Street 1:9601 LILE DR
Mailing Address - Street 2:700 MEDICAL TOWERS BUILDING I
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6321
Mailing Address - Country:US
Mailing Address - Phone:501-219-1970
Mailing Address - Fax:501-219-1944
Practice Address - Street 1:9601 LILE DR
Practice Address - Street 2:700 MEDICAL TOWERS BUILDING I
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6321
Practice Address - Country:US
Practice Address - Phone:501-219-1970
Practice Address - Fax:501-219-1944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-08
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-5295208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARDO9632OtherRAILROAD MEDICARE
ARDO9632OtherRAILROAD MEDICARE