Provider Demographics
NPI:1093742066
Name:AMEDISYS ARKANSAS, L.L.C.
Entity type:Organization
Organization Name:AMEDISYS ARKANSAS, L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SVP TAX
Authorized Official - Prefix:
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MIGLICCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-299-3803
Mailing Address - Street 1:3854 AMERICAN WAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-4013
Mailing Address - Country:US
Mailing Address - Phone:225-292-2031
Mailing Address - Fax:225-295-9678
Practice Address - Street 1:307 W STILLWELL AVE
Practice Address - Street 2:
Practice Address - City:DE QUEEN
Practice Address - State:AR
Practice Address - Zip Code:71832-2860
Practice Address - Country:US
Practice Address - Phone:870-642-4214
Practice Address - Fax:870-642-7782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-27
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR4746B251E00000X
ARAR4746251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR17056OtherBCBS
AR182173514Medicaid
AR125846752OtherMEDICAID ELDERCHOICE
AR182173514Medicaid
AR182173514Medicaid