Provider Demographics
NPI:1316250251
Name:LITTLE ROCK PHYSICAL MEDICINE & REHABILITATION
Entity type:Organization
Organization Name:LITTLE ROCK PHYSICAL MEDICINE & REHABILITATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-223-9775
Mailing Address - Street 1:PO BOX 23804
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72221-3804
Mailing Address - Country:US
Mailing Address - Phone:501-223-9775
Mailing Address - Fax:501-228-9341
Practice Address - Street 1:3127 W 2ND CT
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-4504
Practice Address - Country:US
Practice Address - Phone:479-692-3060
Practice Address - Fax:501-228-9341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-21
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARN78062081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARE41784Medicare UPIN