Neurology Clinic of South Arkansas,PA
Organization Active NPI Neurological Surgery Physician · White Hall, AR
NPI 1124032560 · NPPES record last updated Dec 19, 2024
Key facts
- NPI
- 1124032560
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Neurological Surgery Physician 207T00000X
- Legal business name
- NEUROLOGY CLINIC OF SOUTH ARKANSAS,PA
- Practice address
- 7500 Dollarway Rd Ste 403
White Hall, AR 71602-3083 - Phone
- (870) 247-6160
- Fax
- (870) 247-6167
- NPI assigned
- Jul 29, 2006
- Organization subpart
- No
Authorized official
- Name
- Ghulam Khaleel, MD
- Title
- Director
- Phone
- (870) 863-3373
Practitioners 12
-
Khalid Rayaz, M.D
-
Yulander Gailey, APRN
-
Lesia Pratt, AGPCNP
-
Kanisher Caldwell, APRN
-
Theresa Ann Lybrand, APN
-
Rose A Pace, M.D.
-
Chizoba Usuwa, MD
-
Shailesh C Vora, M. D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 04D2276729 | Neurology Clinic of South Arkansas, PA | Certificate of waiver | Feb 13, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AR
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20051011001001 | AR | Part B Supplier - Clinic/Group Practice | 5698790335 |
Receives reassigned benefits from 5 practitioners Practice locations: Camden, AR; Crossett, AR; Fordyce, AR; Pine Bluff, AR; Sherwood, AR; White Hall, AR |
National Provider Directory
Locations
425 Thompson Ave
El Dorado, AR 71730
Phone (870) 862-5184
7500 Dollarway Rd
Ste 106
White Hall, AR 71602
Phone (870) 247-6160
7500 Dollarway Rd
Ste 403
White Hall, AR 71602
Phone (870) 247-4525
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurological Surgery Physician |
207T00000X | Yes |
Addresses
Primary practice location
7500 Dollarway Rd Ste 403
White Hall, AR 71602-3083
Mailing address
7500 Dollarway Rd Ste 403
White Hall, AR 71602-3083
Phone (870) 247-6160
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5F365 | Other | AR | BLUE CROSS |
| 158303002 | Medicaid | AR |
Other providers in White Hall, AR
- Breanna Montgomery
- Consuela Tortorich Morris
- Shatobeca Moutry
- Dejah Murray
- Veronica Lynn Nelson
- Glynn Nooner
- Amanda Norton
- Olivia M Fisher DC
- Out of Knowhere PLLC
- Dennis Owens
All providers in White Hall, AR · Neurological Surgery Physician in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 19, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.