Anes W. Abraham M.D. P.a.

Primary specialty

SpecialistTaxonomy code 174400000X

License

R3291 Issued in AR

Legal business name

ANES W. ABRAHAM M.D. P.A.

Doing business as

Pediatric and Teen Medical Center

Practice address

1521 N 10TH St
Suite H
Blytheville, AR 72315-1405

Phone

(870) 763-1700

Fax

(870) 763-2903

NPI assigned

Nov 2, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Anes Wiley Abraham, M.D.NPI 1083667703

Title

President

Phone

(870) 763-1700

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Pediatric and Teen Medical Center Doing business as

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Anes Wiley Abraham, MD

  • Pediatrics Physician
  • Blytheville, AR
  • NPI 1083667703
  NPD (past) Authorized official
• Gloria Ann Burns, MD

  • Emergency Medicine Physician
  • Cordova, TN
  • NPI 1932173259
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162425600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1053490144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1521 N 10TH ST",
            "address_2": "SUITE H",
            "city": "BLYTHEVILLE",
            "state": "AR",
            "postal_code": "723151405",
            "telephone_number": "870-763-1700",
            "fax_number": "870-763-2903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1521 N 10TH ST",
            "address_2": "SUITE H",
            "city": "BLYTHEVILLE",
            "state": "AR",
            "postal_code": "723151405",
            "telephone_number": "870-763-1700",
            "fax_number": "870-763-2903"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANES W. ABRAHAM M.D. P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-02",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ABRAHAM",
        "authorized_official_first_name": "ANES",
        "authorized_official_middle_name": "WILEY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "870-763-1700",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "AR",
            "license": "R3291",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLINIC BCBS",
            "identifier": "57920",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pediatric and Teen Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ameris of Arkansas, LLC (Great River Medical Center)
• Jennifer Eunice Anderson Connell, O.D., M.S., B.S.
• Chiquita La'Tarsha Anderson, AAS
• Christina Anderson
• Valencia Marie Andrews-Pirtle, MD
• Arkansas 1St Class Consumer Directed Services LLC
• Arkansas Em-I Byrne Medical Services PA
• Benjamin Asafo-Boakye, MD
• Ascent Acquisitions Corp-PSC (Pediatric Specialty Care)
• Connie Kay Ash, APRN

• Specialist in Blytheville, AR
• Providers in Blytheville, AR by specialty
• Specialist in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.