Provider Demographics
NPI:1912121252
Name:CHILDREN'S HEALTHCARE CLINIC OF SOUTH ARKANSAS
Entity Type:Organization
Organization Name:CHILDREN'S HEALTHCARE CLINIC OF SOUTH ARKANSAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE CO-ORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LORNA
Authorized Official - Middle Name:JAYNE
Authorized Official - Last Name:ANAYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-862-8034
Mailing Address - Street 1:704 W GROVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730
Mailing Address - Country:US
Mailing Address - Phone:870-862-8034
Mailing Address - Fax:870-862-9476
Practice Address - Street 1:704 W GROVE
Practice Address - Street 2:SUITE 4
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730
Practice Address - Country:US
Practice Address - Phone:870-862-8034
Practice Address - Fax:870-862-9476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty