Provider Demographics
NPI:1588876767
Name:ANNIE LUY M.D. PA
Entity type:Organization
Organization Name:ANNIE LUY M.D. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LUY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-279-1472
Mailing Address - Street 1:1407 E RACE AVE
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-4659
Mailing Address - Country:US
Mailing Address - Phone:501-279-1472
Mailing Address - Fax:501-268-4385
Practice Address - Street 1:1407 E RACE AVE
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-4659
Practice Address - Country:US
Practice Address - Phone:501-279-1472
Practice Address - Fax:501-268-4385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE0465261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARG14221Medicare UPIN