LITTLE ROCK VAMC (NPI# 1548457146) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1548457146 |
| Entity Type | Organization |
| Organization Name | LITTLE ROCK VAMC |
| Other Organization Name | PINE BLUFF VA CBOC |
| Practice Address |
4747 Dusty Lake Dr Pine Bluff AR 71603-8742 |
| Mailing Address |
Po Box 94499 Cleveland OH 44101 |
| Practice Telephone | 6153553451 |
| Mailing Telephone | 6153553451 |
| Enumeration Date | 2007-09-27 |
| Last Update Date | 2017-09-26 |
| Authorized Official Name | ERIN POTTER (NPI TEAM MEMBER) |
| Authorized Official Telephone | 2023822579 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QV0200X |
Clinic/Center Specialization: VA |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Pine Bluff VA CBOC | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073821518 | Little Rock Vamc | Clinic/Center | 1520 E Dave Ward Dr, Conway, AR 72032-9649 | 2010-09-17 |
| 1063450617 | Little Rock Vamc | Clinic/Center | 759 Highway 62 E, Suite 331, Mountain Home, AR 72653-3260 | 2006-06-04 |
| 1861439697 | Little Rock Vamc | Clinic/Center | 300 Morrow St S, Mena, AR 71953 | 2006-06-01 |
| 1215982582 | Little Rock Vamc | Clinic/Center | 177 Sawtooth Oak St, Hot Springs, AR 71901-7160 | 2006-05-24 |
| 1215980164 | Little Rock Vamc | Clinic/Center | 1702 N West Ave, El Dorado, AR 71730 | 2006-05-19 |
| 1295120152 | Little Rock Vamc | Clinic/Center | 4300 W 7th St, Little Rock, AR 72205-5446 | 2015-03-30 |
| 1528456894 | Little Rock Vamc | Clinic/Center | 1000 Main St, Little Rock, AR 72202-3820 | 2015-01-08 |
| 1518275056 | Little Rock Vamc | Clinic/Center | 3106 W 2nd Ct, Russellville, AR 72801-4503 | 2010-09-17 |
| 1063745891 | Little Rock Vamc | Clinic/Center | 1120 S Main St, Searcy, AR 72143-7319 | 2009-09-11 |
| 1619926268 | Little Rock Vamc | General Acute Care Hospital | 4300 W 7th St, Little Rock, AR 72205-5446 | 2006-05-10 |
| Street Address |
4747 DUSTY LAKE DR |
| City | PINE BLUFF |
| State | AR |
| Zip Code | 71603-8742 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518922632 | Paul W Davis Md Pa | Family Medicine | 4747 Dusty Lake Dr, Ste G1, Pine Bluff, AR 71603-9056 | 2006-04-20 |
| 1497102040 | Jefferson Hospital Association, Inc | Family Medicine | 4747 Dusty Lake Dr, Suite 202, Pine Bluff, AR 71603-8742 | 2016-05-24 |
| 1326354739 | Leslie Amber Adams | Nurse Practitioner | 4747 Dusty Lake Dr, Suite G1, Pine Bluff, AR 71603-8742 | 2010-08-23 |
| 1578892097 | Physician's Sleep Clinic Pllc | Clinic/Center | 4747 Dusty Lake Dr, Suite 204, Pine Bluff, AR 71603-8742 | 2009-12-11 |
| 1861685570 | Roslyn Denise Burks | Nurse Practitioner | 4747 Dusty Lake Dr, Suite G-1, Pine Bluff, AR 71603-8742 | 2007-08-26 |
| 1780877969 | Kenneth Doyne Dill | Family Medicine | 4747 Dusty Lake Dr, Suite 202, Pine Bluff, AR 71603-8742 | 2007-08-22 |
| 1598961047 | Bryan D. Raymundo | Family Medicine | 4747 Dusty Lake Dr, Suite 203, Pine Bluff, AR 71603-9058 | 2007-06-22 |
| 1881776987 | University of Arkansas Medical Sciences, Ahec Pine Bluff | Clinic/Center | 4747 Dusty Lake Dr, Ste 203, Pine Bluff, AR 71603-8742 | 2006-10-19 |
| 1831130764 | Jefferson Hospital Association Inc | Family Medicine | 4747 Dusty Lake Dr, Suite 202, Pine Bluff, AR 71603-8742 | 2006-06-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700445038 | Hannah Carter | Dentist | 3801 S Olive St, Pine Bluff, AR 71603 | 2019-06-11 |
| 1821544628 | Nauman Yunus Md Pa | Internal Medicine | 1600 West 40th Ave, Jefferson Regional Medical Center, Pine Bluff, AR 71603 | 2016-08-31 |
| 1407278120 | Arkansas Cancer Clinic Pa | Radiology | 7200 South Hazel Street, Pine Bluff, AR 71603 | 2014-01-15 |
| 1730515396 | Sharon Yvette Webb | Student in an Organized Health Care Education/Training Program | 2318 Kyle Street, Pine Bluff, AR 71603 | 2013-09-16 |
| 1477992733 | David Larry Byrd | Pharmacist | 5 Longmeadow, Pine Bluff, AR 71603 | 2013-06-20 |
| 1437400371 | Thomas Jordan Harper | Pharmacist | 2809 South Camden Road, Pine Bluff, AR 71603 | 2012-10-01 |
| 1992080469 | C&d Disability.inc | Early Intervention Provider Agency | 4806 W 9th Street, Pine Bluff, AR 71603 | 2011-10-17 |
| 1457645863 | Clifton G Roaf & Marvin Q Caudle | Dentist | 1310 South Linden Street, Pine Bluff, AR 71603 | 2011-06-02 |
| 1932402682 | Mary Campbell | Licensed Practical Nurse | 2302 W. 28th, Suite A, Pine Bluff, AR 71603 | 2010-12-17 |
| 1245468925 | Evan N Newbolt | Ophthalmology | 3805 West 28th Ave, Pine Bluff, AR 71603 | 2009-07-01 |
| Find all providers in zip 71603 | ||||
| Taxonomy Code | 261QV0200X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | VA |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528456811 | Fayetteville Vamc | Clinic/Center | 216 East Township Street, Fayetteville, AR 72703-2818 | 2015-01-08 |
| 1073821518 | Little Rock Vamc | Clinic/Center | 1520 E Dave Ward Dr, Conway, AR 72032-9649 | 2010-09-17 |
| 1831415751 | Fayetteville Vamc | Clinic/Center | 2713 W Commercial St, Ozark, AR 72949-3409 | 2010-04-16 |
| 1649401316 | Memphis Vamc | Clinic/Center | 125 Quarles Ln, West Helena, AR 72390-1923 | 2009-07-29 |
| 1508809948 | St. Louis Jc Vamc | Clinic/Center | 2420 Linwood Dr, Suite 3, Paragould, AR 72450-6122 | 2006-06-14 |
| 1417996489 | Shreveport Vamc | Clinic/Center | 910 Realtor Road, Texarkana, AR 71854-1020 | 2006-06-05 |
| 1063450617 | Little Rock Vamc | Clinic/Center | 759 Highway 62 E, Suite 331, Mountain Home, AR 72653-3260 | 2006-06-04 |
| 1861439697 | Little Rock Vamc | Clinic/Center | 300 Morrow St S, Mena, AR 71953 | 2006-06-01 |
| 1619923398 | Memphis Vamc | Clinic/Center | 2908 S Caraway Rd Ste B, Jonesboro, AR 72401-7306 | 2006-05-25 |
| 1215982582 | Little Rock Vamc | Clinic/Center | 177 Sawtooth Oak St, Hot Springs, AR 71901-7160 | 2006-05-24 |
| Find all providers with the same taxonomy | ||||
| City | PINE BLUFF |
| Zip Code | 71603 |
Please comment or provide details below to improve the information on LITTLE ROCK VAMC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.