Provider Demographics
NPI:1700905296
Name:THE DOCTOR'S OFFICE OF MARKED TREE
Entity Type:Organization
Organization Name:THE DOCTOR'S OFFICE OF MARKED TREE
Other - Org Name:KIMITAKA SAITO, MD
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:KIMITAKA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAITO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-358-4355
Mailing Address - Street 1:PO BOX 616
Mailing Address - Street 2:
Mailing Address - City:MARKED TREE
Mailing Address - State:AR
Mailing Address - Zip Code:72365-0616
Mailing Address - Country:US
Mailing Address - Phone:870-358-4355
Mailing Address - Fax:870-358-4357
Practice Address - Street 1:202 NEWSOME DR
Practice Address - Street 2:
Practice Address - City:MARKED TREE
Practice Address - State:AR
Practice Address - Zip Code:72365-2021
Practice Address - Country:US
Practice Address - Phone:870-358-4355
Practice Address - Fax:870-358-4357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR2736207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR142472002Medicaid
AR142472002Medicaid