Organization
VAMANA INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIMICA JOHNSON (CREDENTIALING / BILLING SPECIALIST)
(870) 773-1111
Entity
Organization
Contact information
Practice address
422 BEECH ST, TEXARKANA, AR 71854-5310
(870) 773-1111
(870) 772-7692
Mailing address
422 BEECH ST, TEXARKANA, AR 71854-5310
(870) 773-1111
(870) 772-7692
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
166879134
—
AR
Enumeration date
06/16/2006
Last updated
03/13/2020
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