Provider Demographics
NPI:1396809711
Name:PLASTIC SURGERY ASSOCIATES OF NORTHEAST ARKANSAS, P.A.
Entity type:Organization
Organization Name:PLASTIC SURGERY ASSOCIATES OF NORTHEAST ARKANSAS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:HIERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-935-0861
Mailing Address - Street 1:1003 WINDOVER RD
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-6007
Mailing Address - Country:US
Mailing Address - Phone:870-935-0861
Mailing Address - Fax:870-972-5241
Practice Address - Street 1:1003 WINDOVER RD
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-6007
Practice Address - Country:US
Practice Address - Phone:870-935-0861
Practice Address - Fax:870-972-5241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR3542174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5B105OtherBCBS CLINIC PROVIDER
AR118638002Medicaid
AR118638002Medicaid
AR5B105OtherBCBS CLINIC PROVIDER