Provider Demographics
NPI:1124124391
Name:CENTRAL ARKANSAS WOMENS CLINIC P.A.
Entity type:Organization
Organization Name:CENTRAL ARKANSAS WOMENS CLINIC P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARCY
Authorized Official - Middle Name:L
Authorized Official - Last Name:LUMPKINS
Authorized Official - Suffix:
Authorized Official - Credentials:CLINIC MANAGER
Authorized Official - Phone:501-778-0427
Mailing Address - Street 1:PO BOX 2577
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72018
Mailing Address - Country:US
Mailing Address - Phone:501-778-0427
Mailing Address - Fax:501-778-5993
Practice Address - Street 1:910 NORTH EAST STREET
Practice Address - Street 2:STE 206
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015
Practice Address - Country:US
Practice Address - Phone:501-778-0427
Practice Address - Fax:501-778-5993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE2226174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR150120002Medicaid
AR150120002Medicaid