Provider Demographics
NPI:1548256076
Name:ARKANSAS REHABILITATION SERVICES
Entity type:Organization
Organization Name:ARKANSAS REHABILITATION SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL SERVICES MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-701-6217
Mailing Address - Street 1:105 RESERVE ST
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71901-4195
Mailing Address - Country:US
Mailing Address - Phone:501-701-6217
Mailing Address - Fax:501-624-0019
Practice Address - Street 1:105 RESERVE ST
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-4195
Practice Address - Country:US
Practice Address - Phone:501-701-6217
Practice Address - Fax:501-624-0019
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ARKANSAS REHABILITATION SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-09-20
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR107207QA0505X
AR04D0642139283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes283X00000XHospitalsRehabilitation Hospital
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR111208526OtherHSRC DENTAL CLINIC
AR111208526Medicaid
AR131458002OtherPHYSICIANS CLINIC
AR169599744OtherPSYCH SERVICES
AR57533OtherMEDICARE PART B
AR127038126OtherRSPD MEDICAID
AR131458002OtherPHYSICIANS CLINIC