NPIMap

Organization Active NPI

Arkansas Liver and Gastroenterology, PA

Doing business as Southside Specialty Pharmacy

  • Clinic Pharmacy
  • Fort Smith, AR
National Provider Identifier
1194186056
Registry record updated Mar 18, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic PharmacyTaxonomy code 3336C0002X
License
AR20829 Issued in AR
Legal business name
ARKANSAS LIVER AND GASTROENTEROLOGY, PA
Doing business as
Southside Specialty Pharmacy
Practice address
3416 Old Greenwood Rd Ste a
Fort Smith, AR 72903-5462
Phone
(479) 242-2888
Fax
(479) 242-2889
NPI assigned
Mar 18, 2016
Last updated
Mar 18, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2016

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

Authorized official

Name
Dr. Ihab Herraka, M.D.NPI 1174610018
Title
President
Phone
(479) 242-2888

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic Pharmacy 3336C0002X AR20829 AR Primary
Community/Retail Pharmacy 3336C0003X AR20829 AR
Mail Order Pharmacy 3336M0002X AR20829 AR

Addresses

Primary practice location

3416 Old Greenwood Rd Ste a
Fort Smith, AR 72903-5462

Mailing address

3416 Old Greenwood Rd Ste a
Fort Smith, AR 72903-5462
Phone (479) 242-2888

Other names 1

  • Southside Specialty Pharmacy Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Arkansas Liver and Gastroenterology PA12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

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

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1458259200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1458259200000",
    "number": "1194186056",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3416 OLD GREENWOOD RD STE A",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729035462",
            "telephone_number": "479-242-2888",
            "fax_number": "479-242-2889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3416 OLD GREENWOOD RD STE A",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729035462",
            "telephone_number": "479-242-2888",
            "fax_number": "479-242-2889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ARKANSAS LIVER AND GASTROENTEROLOGY, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-18",
        "last_updated": "2016-03-18",
        "status": "A",
        "authorized_official_last_name": "HERRAKA",
        "authorized_official_first_name": "IHAB",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "479-242-2888",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": "AR",
            "license": "AR20829",
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "AR",
            "license": "AR20829",
            "primary": false
        },
        {
            "code": "3336M0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Mail Order Pharmacy",
            "state": "AR",
            "license": "AR20829",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southside Specialty Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Smith, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2016; 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.