| Organization Name: | INTEGRATIVE MEDICAL CENTER OF ARKANSAS PA |
| NPI Number: | 1134595234 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DAVID C HAAS (OWNER) |
| Mailing Address: | 2001 Club Manor Dr Suite D Maumelle |
| State: | AR US |
| Postal Code: | 721137411 |
| Phone Number: | 5017736318 |
| Fax Number: | 5016870489 |
| NPI Enumeration Date: | 08/12/2015 |
| NPI Last Update Date: | 08/12/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |