Provider Demographics
NPI:1801503511
Name:ENCORE PEDIATRICS OF ARKANSAS, LLC
Entity type:Organization
Organization Name:ENCORE PEDIATRICS OF ARKANSAS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:IAN
Authorized Official - Middle Name:
Authorized Official - Last Name:OPPEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-269-9876
Mailing Address - Street 1:89 STATE ROAD 331 # 1018
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72802-9645
Mailing Address - Country:US
Mailing Address - Phone:248-672-2593
Mailing Address - Fax:
Practice Address - Street 1:89 STATE ROAD 331 # 1018
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72802-9645
Practice Address - Country:US
Practice Address - Phone:248-672-2593
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-02
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty