Provider Demographics
NPI:1427155316
Name:MENA CENTER FOR WOMENS HEALTH, PA
Entity type:Organization
Organization Name:MENA CENTER FOR WOMENS HEALTH, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:BARRETT
Authorized Official - Last Name:ROCHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-394-2534
Mailing Address - Street 1:400 CRESTWOOD CIR STE P
Mailing Address - Street 2:
Mailing Address - City:MENA
Mailing Address - State:AR
Mailing Address - Zip Code:71953-5512
Mailing Address - Country:US
Mailing Address - Phone:479-394-2534
Mailing Address - Fax:479-394-7012
Practice Address - Street 1:400 CRESTWOOD CIR STE P
Practice Address - Street 2:
Practice Address - City:MENA
Practice Address - State:AR
Practice Address - Zip Code:71953-5512
Practice Address - Country:US
Practice Address - Phone:479-394-2534
Practice Address - Fax:479-394-7012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE2878207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5L863OtherBLUECROSS NUMBER
AR143840001Medicaid
AR5L863Medicare ID - Type Unspecified
AR143840001Medicaid