Provider Demographics
NPI:1538134820
Name:ARKANSAS NEPHROLOGY SERVICES, LTD.
Entity type:Organization
Organization Name:ARKANSAS NEPHROLOGY SERVICES, LTD.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CECI
Authorized Official - Middle Name:
Authorized Official - Last Name:SAVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-624-6000
Mailing Address - Street 1:115 WRIGHTS ST
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-6240
Mailing Address - Country:US
Mailing Address - Phone:501-624-6000
Mailing Address - Fax:501-321-0710
Practice Address - Street 1:3121 W 2ND CT
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-4504
Practice Address - Country:US
Practice Address - Phone:479-968-4687
Practice Address - Fax:479-968-2260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-21
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR116959134Medicaid
AR042508Medicare ID - Type Unspecified