Provider Demographics
NPI:1952358657
Name:ARKANSAS GASTROENTEROLOGY
Entity Type:Organization
Organization Name:ARKANSAS GASTROENTEROLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:SNOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-945-3343
Mailing Address - Street 1:3401 SPRINGHILL DR
Mailing Address - Street 2:STE 400
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72117-2924
Mailing Address - Country:US
Mailing Address - Phone:501-945-3343
Mailing Address - Fax:501-945-0770
Practice Address - Street 1:3401 SPRINGHILL DR
Practice Address - Street 2:STE 400
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72117-2924
Practice Address - Country:US
Practice Address - Phone:501-945-3343
Practice Address - Fax:501-945-0770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARMC1180174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR57551OtherBLUE ADVANTAGE
AR57551OtherAR BLUE CROSS BLUE SHIELD
AR57551OtherFIRST SOURCE
AR57551OtherHEALTH ADVANTAGE
AR57551Medicare ID - Type Unspecified