Provider Demographics
NPI:1831821040
Name:PAIN MEDICINE SPECIALISTS OF ARKANSAS PA
Entity type:Organization
Organization Name:PAIN MEDICINE SPECIALISTS OF ARKANSAS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIO
Authorized Official - Middle Name:
Authorized Official - Last Name:OLAYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-231-0182
Mailing Address - Street 1:PO BOX 9178
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72811-9178
Mailing Address - Country:US
Mailing Address - Phone:800-824-4094
Mailing Address - Fax:479-968-1673
Practice Address - Street 1:1225 BRECKENRIDGE DR STE 106
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-1565
Practice Address - Country:US
Practice Address - Phone:501-451-2500
Practice Address - Fax:479-968-1673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-27
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty