Provider Demographics
NPI:1124153259
Name:LLE MEDICAL MANAGEMENT
Entity type:Organization
Organization Name:LLE MEDICAL MANAGEMENT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:L
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:501-279-0211
Mailing Address - Street 1:606 W ARCH AVE
Mailing Address - Street 2:STE A
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-5206
Mailing Address - Country:US
Mailing Address - Phone:501-279-0211
Mailing Address - Fax:501-279-0213
Practice Address - Street 1:606 W ARCH AVE
Practice Address - Street 2:STE A
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-5206
Practice Address - Country:US
Practice Address - Phone:501-279-0211
Practice Address - Fax:501-279-0213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAO1691363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5X331Medicare ID - Type Unspecified
ARP85660Medicare UPIN