| Uams South Central | |
|
1601 W 40th Ave Pine Bluff AR 71603-6069 | |
| (870) 541-6000 | |
| (870) 541-3198 |
| Full Name | Uams South Central |
|---|---|
| Speciality | Family Medicine |
| Location | 1601 W 40th Ave, Pine Bluff, Arkansas |
| Authorized Official Name and Position | Amanda George (VICE CHANCELLOR-CHIEF FINANCIAL OFF) |
| Authorized Official Contact | 5016865670 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Uams South Central Po Box 251420 Little Rock AR 72225-1420 Ph: (501) 686-8000 | Uams South Central 1601 W 40th Ave Pine Bluff AR 71603-6069 Ph: (870) 541-6000 |
| NPI Number | 1831144120 |
|---|---|
| Provider Enumeration Date | 05/24/2006 |
| Last Update Date | 07/12/2023 |
| Medicare PECOS PAC ID | 4082528955 |
|---|---|
| Medicare Enrollment ID | O20040709000013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831144120 | NPI | - | NPPES |
| 102962069 | Medicaid | AR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 261QC1500X | Clinic/center - Community Health | (* (Not Available)) | Secondary |
| Provider Name | Toni Middleton |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1093750671 PECOS PAC ID: 4587646781 Enrollment ID: I20040602000828 |
| Provider Name | Steven Wright |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1598771677 PECOS PAC ID: 2769392810 Enrollment ID: I20080626000360 |
| Provider Name | Herbert Farrell Fendley |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1568499986 PECOS PAC ID: 8820153729 Enrollment ID: I20090209000670 |
| Provider Name | Harvie Marks Attwood |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1568407088 PECOS PAC ID: 8628112471 Enrollment ID: I20100218000113 |
| Provider Name | Darrell R Over |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1700842218 PECOS PAC ID: 4789691759 Enrollment ID: I20100713000363 |
| Provider Name | Richard Justiss |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1982631313 PECOS PAC ID: 6002726726 Enrollment ID: I20100715000902 |
| Provider Name | Mary E Meek |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1891910808 PECOS PAC ID: 8628101698 Enrollment ID: I20100728001001 |
| Provider Name | Jason B Cobb |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1215164629 PECOS PAC ID: 1052531209 Enrollment ID: I20141010000158 |
| Provider Name | Katrena L Gordon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952769614 PECOS PAC ID: 2769788165 Enrollment ID: I20160310002238 |
| Provider Name | Nathan Probst |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1508213984 PECOS PAC ID: 8527333251 Enrollment ID: I20171006000074 |
| Provider Name | William Brainerd Ventres |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1932251006 PECOS PAC ID: 5395731509 Enrollment ID: I20171030001194 |
| Provider Name | Rayna B Penister |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1619354818 PECOS PAC ID: 4981917101 Enrollment ID: I20181130002218 |
| Provider Name | Elizabeth Eoff |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1851827679 PECOS PAC ID: 9739454489 Enrollment ID: I20191105001508 |
| Provider Name | Raj B Patel |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1366888711 PECOS PAC ID: 2769734813 Enrollment ID: I20200817002914 |
| Provider Name | Pavana Tirumanisetti |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1083920086 PECOS PAC ID: 5395975213 Enrollment ID: I20200928002555 |
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