Provider Demographics
NPI:1265767008
Name:ROUGEAU GROUP P A
Entity type:Organization
Organization Name:ROUGEAU GROUP P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLAY
Authorized Official - Middle Name:H
Authorized Official - Last Name:ROUGEAU
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:501-428-8868
Mailing Address - Street 1:805 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-7273
Mailing Address - Country:US
Mailing Address - Phone:501-428-8868
Mailing Address - Fax:
Practice Address - Street 1:455 HOGAN LN
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-8201
Practice Address - Country:US
Practice Address - Phone:501-513-0799
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-13
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC00616367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty