Provider Demographics
NPI:1871756437
Name:PHYSICIAN'S MANAGEMENT GROUP
Entity type:Organization
Organization Name:PHYSICIAN'S MANAGEMENT GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:FARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-663-4204
Mailing Address - Street 1:501 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-3927
Mailing Address - Country:US
Mailing Address - Phone:501-663-4204
Mailing Address - Fax:501-663-4233
Practice Address - Street 1:2520 W MAIN ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72076-4214
Practice Address - Country:US
Practice Address - Phone:501-982-0528
Practice Address - Fax:501-985-7777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC5129103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental DisabilitiesGroup - Single Specialty