Provider Demographics
NPI:1205280138
Name:CENTRAL ARKANSAS SPINE SPECIALIST
Entity type:Organization
Organization Name:CENTRAL ARKANSAS SPINE SPECIALIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:KIPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-776-6039
Mailing Address - Street 1:PO BOX 1615
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72145-1615
Mailing Address - Country:US
Mailing Address - Phone:501-776-6252
Mailing Address - Fax:501-776-6271
Practice Address - Street 1:5 MEDICAL PARK DR
Practice Address - Street 2:STE 308
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015-3729
Practice Address - Country:US
Practice Address - Phone:501-776-6545
Practice Address - Fax:501-776-6546
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SALINE PHYSICIAN SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-04-18
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies