Provider Demographics
NPI:1861972481
Name:ID OF CENTRAL ARKANSAS, PLLC
Entity type:Organization
Organization Name:ID OF CENTRAL ARKANSAS, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:NOVACK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-503-3000
Mailing Address - Street 1:3500 SPRINGHILL DR STE 200B
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72117-2948
Mailing Address - Country:US
Mailing Address - Phone:501-503-3000
Mailing Address - Fax:501-503-0466
Practice Address - Street 1:3500 SPRINGHILL DR STE 200B
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72117
Practice Address - Country:US
Practice Address - Phone:501-503-3000
Practice Address - Fax:501-503-0466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-14
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty