Provider Demographics
NPI:1306996145
Name:JACK A. CATES, M.D.P.A.
Entity type:Organization
Organization Name:JACK A. CATES, M.D.P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOSSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-624-3376
Mailing Address - Street 1:1710 MALVERN AVE
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71901-7132
Mailing Address - Country:US
Mailing Address - Phone:501-624-3376
Mailing Address - Fax:501-624-5609
Practice Address - Street 1:1710 MALVERN AVE
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-7132
Practice Address - Country:US
Practice Address - Phone:501-624-3376
Practice Address - Fax:501-624-5609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR-2487207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR57490Medicare ID - Type Unspecified