Provider Demographics
NPI:1174585061
Name:NEUROLOGY ASSOCIATES OF NORTHEAST ARKANSAS PA
Entity type:Organization
Organization Name:NEUROLOGY ASSOCIATES OF NORTHEAST ARKANSAS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RON
Authorized Official - Middle Name:E
Authorized Official - Last Name:SOUTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-931-4442
Mailing Address - Street 1:1107 E MATTHEWS AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-4315
Mailing Address - Country:US
Mailing Address - Phone:870-931-4442
Mailing Address - Fax:870-802-0205
Practice Address - Street 1:1107 E MATTHEWS AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-4315
Practice Address - Country:US
Practice Address - Phone:870-931-4442
Practice Address - Fax:870-802-0205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-05
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR143512002Medicaid
AR143512002Medicaid