NPIMap

Organization Active NPI

Texarkana Behavioral Associates LC

  • Psychiatry Physician
  • Fayetteville, AR
National Provider Identifier
1114040888
Registry record updated Aug 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
TEXARKANA BEHAVIORAL ASSOCIATES LC
Practice address
4253 N Crossover Rd
Fayetteville, AR 72703-4593
Phone
(479) 521-5731
Fax
(479) 521-4926
NPI assigned
Apr 9, 2007
Last updated
Aug 27, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2023

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

Authorized official

Name
Brian P. Farley
Title
Vice President & Secretary
Phone
(615) 861-6000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X Primary

Addresses

Primary practice location

4253 N Crossover Rd
Fayetteville, AR 72703-4593

Mailing address

4253 N Crossover Rd
Fayetteville, AR 72703-4593
Phone (479) 521-5731

Other identifiers 1

IdentifierTypeStateIssuer
162558002MedicaidAR

Other names 1

  • VISTA HEALTH PHYSICAN GROUP Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040223000353 AR Part B Supplier - Clinic/Group Practice 9436062379 Receives reassigned benefits from 52 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Texarkana, AR; Barling, AR; Prescott, AR; Fayetteville, AR

Other NPIs on the same Medicare enrollment 7

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Vista Health18 organizations share this tax ID, including this one

Other organizations with this tax ID 17

Organizations that report the same tax identification number in the National Provider Directory.

View all 17

Practitioners & affiliated clinicians

Practitioners 14

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.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1176076800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693094400000",
    "number": "1114040888",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4253 N CROSSOVER RD",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727034593",
            "telephone_number": "479-521-5731",
            "fax_number": "479-521-4926"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4253 N CROSSOVER RD",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727034593",
            "telephone_number": "479-521-5731",
            "fax_number": "479-521-4926"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TEXARKANA BEHAVIORAL ASSOCIATES LC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-09",
        "last_updated": "2023-08-27",
        "certification_date": "2023-08-27",
        "status": "A",
        "authorized_official_last_name": "FARLEY",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "P.",
        "authorized_official_title_or_position": "VICE PRESIDENT & SECRETARY",
        "authorized_official_telephone_number": "615-861-6000"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "162558002",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "VISTA HEALTH PHYSICAN GROUP",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "VISTA HEALTH PHYSICAN GROUP",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Fayetteville, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.