Provider Demographics
NPI:1750421269
Name:SOUTH ARKANSAS CLINIC FOR WOMEN
Entity type:Organization
Organization Name:SOUTH ARKANSAS CLINIC FOR WOMEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REID
Authorized Official - Middle Name:
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-536-2496
Mailing Address - Street 1:1801 W 40TH AVE
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-6940
Mailing Address - Country:US
Mailing Address - Phone:870-536-2496
Mailing Address - Fax:870-536-9342
Practice Address - Street 1:1801 W 40TH AVE
Practice Address - Street 2:SUITE 1A
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-6940
Practice Address - Country:US
Practice Address - Phone:870-536-2496
Practice Address - Fax:870-536-9342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-6299207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARC67819Medicare UPIN
AR5B158Medicare ID - Type Unspecified