Organization
EVGUENI ROUDACHEVSKI, D.O.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. HAPSY GLOVER APN (APN)
(501) 227-8020
Entity
Organization
Contact information
Practice address
11912 KANIS RD STE F2, LITTLE ROCK, AR 72211-3771
(501) 227-8020
(501) 227-8826
Mailing address
11912 KANIS RD STE F2, LITTLE ROCK, AR 72211-3771
(501) 227-8020
(501) 227-8826
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
A03199
AR
314000000X
Skilled Nursing Facility
A03199
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1568763514
NPI
AR
05
—
186702758
—
AR
Enumeration date
09/12/2014
Last updated
09/12/2014
Update your record
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