NPI 1255771531

Arkansas

Organisation Exclusive Provider Organization Pine Bluff, AR

Practice location

Address: 412 W 6th Ave, Pine Bluff, AR 71601-4136
Phone: (501) 690-1328
Fax: (501) 562-0327
Mailing address: 2011 Hillsborough Ln, Little Rock, AR 72212-3730

Authorised official

Name: Jana Rene Foley
Title: Managing Member
Phone: (501) 690-1328

Registered specialties

Exclusive Provider Organization Primary

Managed Care Organizations Taxonomy 302F00000X

Other Exclusive Provider Organization providers in Arkansas →

Registry record

NPI: 1255771531
Entity type: Organization
NPI issued: 1 Jul 2013
Record last updated: 1 Jul 2013

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.