Arkansas Liver and Gastroenterology, PA
Organization Active NPI Clinic/Center · Bethany, OK
NPI 1366943151 · NPPES record last updated Feb 27, 2018
Key facts
- NPI
- 1366943151
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinic/Center 261Q00000X
- Legal business name
- ARKANSAS LIVER AND GASTROENTEROLOGY, PA
- Practice address
- 2347 North Thompkins Ave
Bethany, OK 73008 - Phone
- (479) 242-2888
- Fax
- (479) 242-2889
- NPI assigned
- Feb 27, 2018
- Organization subpart
- No
Authorized official
- Name
- Mrs. Sarah Jessica-Elise Coluccino
- Title
- Office Manager
- Phone
- (479) 242-2888
Corporate family (same tax ID) 11
Practitioners 1
-
Ihab Herraka, M.D.
National Provider Directory
- Tax ID family
- Ar Liver and Ge
Locations
2347 N Thompkins Ave
Bethany, OK 73008
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | Yes |
Addresses
Primary practice location
2347 North Thompkins Ave
Bethany, OK 73008
Mailing address
3416 Old Greenwood Road
Fort Smith, AR 72903
Phone (479) 242-2888
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 21089002 | Medicaid | AR | |
| 2006036301A | Medicaid | OK |
Other names
- The Liver Care Clinics
Other providers in Bethany, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 27, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.