| Sidarous, Llc | |
|
11521 W Markham St Little Rock AR 72211-2701 | |
| (501) 502-2765 | |
| (501) 302-1991 |
| Full Name | Sidarous, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 11521 W Markham St, Little Rock, Arkansas |
| Authorized Official Name and Position | Peter Sidarous (OWNER) |
| Authorized Official Contact | 7173199672 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sidarous, Llc 11521 W Markham St Little Rock AR 72211-2701 Ph: (501) 502-2765 | Sidarous, Llc 11521 W Markham St Little Rock AR 72211-2701 Ph: (501) 502-2765 |
| NPI Number | 1326531534 |
|---|---|
| Provider Enumeration Date | 06/12/2018 |
| Last Update Date | 03/04/2021 |
| Medicare PECOS PAC ID | 2163778085 |
|---|---|
| Medicare Enrollment ID | O20180709001076 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326531534 | NPI | - | NPPES |
| 219215001 | Medicaid | AR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | E100-91 (Arkansas) | Primary |
| Provider Name | Sara Hanna |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1497986368 PECOS PAC ID: 2567628969 Enrollment ID: I20120731000245 |
| Provider Name | Peter Sidarous |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1881072544 PECOS PAC ID: 8123302486 Enrollment ID: I20170306000271 |
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