NPI 1831220334

Pediatric Specialty Care

Organisation Exclusive Provider Organization Arkadelphia, AR

Practice location

Address: 2410 Pine St, Arkadelphia, AR 71923-4335
Phone: (870) 245-2210
Mailing address: 141 Grisham Rd, Royal, AR 71968-9563

Authorised official

Name: Larry Lamar Grant
Title: Mental Health Professional
Phone: (870) 245-2210

Registered specialties

Exclusive Provider Organization Primary

Managed Care Organizations Taxonomy 302F00000X Licence P0607039 (AR)

Other Exclusive Provider Organization providers in Arkansas →

Registry record

NPI: 1831220334
Entity type: Organization
NPI issued: 8 Mar 2007
Record last updated: 22 Aug 2020

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.