1366450421 NPI number — REHAB AND PAIN MANAGMENT CLINIC INC.

Table of content: (NPI 1366450421)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366450421 NPI number — REHAB AND PAIN MANAGMENT CLINIC INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REHAB AND PAIN MANAGMENT CLINIC INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366450421
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 1191
Provider Second Line Business Mailing Address:
REHAB AND PAIN MANAGEMENT CLINIC
Provider Business Mailing Address City Name:
JONESBORO
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72403
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-275-6010
Provider Business Mailing Address Fax Number:
870-203-0945

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1201 FLEMING AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JONESBORO
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72401-4311
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-275-6010
Provider Business Practice Location Address Fax Number:
870-203-0945
Provider Enumeration Date:
08/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
VERMA
Authorized Official First Name:
VIRENDAR
Authorized Official Middle Name:
KUMAR
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
870-536-6700

Provider Taxonomy Codes

  • Taxonomy code: 2081P2900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QM2500X , with the licence number: R-4265 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 120955001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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