Provider Demographics
NPI:1366538134
Name:ARKANSAS SPECIALTY THERAPY AND DIAGNOSTIC CENTERS LLC
Entity type:Organization
Organization Name:ARKANSAS SPECIALTY THERAPY AND DIAGNOSTIC CENTERS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:HIBBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-978-2613
Mailing Address - Street 1:600 S MCKINLEY ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-5202
Mailing Address - Country:US
Mailing Address - Phone:501-663-3647
Mailing Address - Fax:501-663-1706
Practice Address - Street 1:600 S MCKINLEY ST
Practice Address - Street 2:SUITE 300
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205
Practice Address - Country:US
Practice Address - Phone:501-663-3647
Practice Address - Fax:501-663-1706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARMC1964225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5C153OtherABCBS
AR046577Medicare Oscar/Certification