Provider Demographics
NPI:1972480945
Name:GENERATIONAL HEALTH OF ARKANSAS
Entity type:Organization
Organization Name:GENERATIONAL HEALTH OF ARKANSAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EEMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TARIQ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-338-9901
Mailing Address - Street 1:1100 OAK ST STE V27
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-4318
Mailing Address - Country:US
Mailing Address - Phone:713-338-9901
Mailing Address - Fax:713-338-9902
Practice Address - Street 1:1100 OAK ST STE V27
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-4318
Practice Address - Country:US
Practice Address - Phone:713-338-9901
Practice Address - Fax:713-338-9902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-20
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center