Organization
NORTHEAST ARKANSAS PAIN MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MONICA R FORMON (OFFICE MANAGER)
(870) 972-0411
Entity
Organization
Contact information
Practice address
505 E MATTHEWS AVE, SUITE 103, JONESBORO, AR 72401-3144
(870) 972-0411
(870) 933-8011
Mailing address
505 E MATTHEWS AVE, SUITE 103, JONESBORO, AR 72401-3144
(870) 972-0411
(870) 933-8011
Taxonomy
Speciality
Code
Description
License number
State
208VP0014X
Interventional Pain Medicine Physician
Primary
E1479
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
143853002
—
AR
01
—
5K398
BLUE CROSS
AR
Enumeration date
03/12/2008
Last updated
12/15/2009
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