Provider Demographics
NPI:1992146856
Name:CENTRAL ARKANSAS VEIN CENTER, PA
Entity type:Organization
Organization Name:CENTRAL ARKANSAS VEIN CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:ENNS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-404-9582
Mailing Address - Street 1:1100 N UNIVERSITY AVE STE 142
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72207-6344
Mailing Address - Country:US
Mailing Address - Phone:501-404-9582
Mailing Address - Fax:501-404-9663
Practice Address - Street 1:1100 N UNIVERSITY AVE STE 142
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72207-6344
Practice Address - Country:US
Practice Address - Phone:501-404-9582
Practice Address - Fax:501-404-9663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-08
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty