Provider Demographics
NPI:1588775464
Name:WREN & BARROW OB GYN PLLC PA
Entity type:Organization
Organization Name:WREN & BARROW OB GYN PLLC PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:LANGSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-425-7300
Mailing Address - Street 1:628 HOSPITAL DR STE 2A
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-2937
Mailing Address - Country:US
Mailing Address - Phone:870-425-7300
Mailing Address - Fax:870-425-4431
Practice Address - Street 1:628 HOSPITAL DR STE 2A
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-2937
Practice Address - Country:US
Practice Address - Phone:870-425-7300
Practice Address - Fax:870-425-4431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR158631001Medicaid
AR154300002Medicaid
AR128146001Medicaid
AR143910001Medicaid
AR5N410Medicare ID - Type UnspecifiedES MCR #
AR5J837Medicare ID - Type UnspecifiedMW MCR #
AR143910001Medicaid
ARI42204Medicare UPIN
ARF83275Medicare UPIN
ARE3392Medicare ID - Type UnspecifiedCFW MCR#
AR158631001Medicaid