PEDIATRIC ASSOCIATES OF WEST MEMPHIS PLLC NPI 1407966005

NPI Information

  • NPI: 1407966005
  • Provider Name: PEDIATRIC ASSOCIATES OF WEST MEMPHIS, PLLC
  • Classification: Clinic/Center - 261Q00000X
  • Entity Type: Organization
  • CLIA Number: 04D0467679
  • Address: 108 W TYLER
    WEST MEMPHIS, AR
    ZIP 72301
  • Phone: (870) 732-1191

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NPI Details

PEDIATRIC ASSOCIATES OF WEST MEMPHIS, PLLC is a clinic center in West Memphis, AR. The provider is a facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). PEDIATRIC ASSOCIATES OF WEST MEMPHIS, PLLC NPI is 1407966005. The provider is registered as an organization entity type.

The provider's business location address is:

108 W TYLER
WEST MEMPHIS, AR
ZIP 72301-221
Phone: (870) 732-1191
Fax: (870) 732-4091

The provider's authorized official is Robin Weaver .
The authorized official title is Practice Manager and has the following contact phone number (870) 732-1191.

The CLIA number assigned to this NPI record is 04D0467679 - physician office with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 8/30/2006 and was last updated on 3/14/2016.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261Q00000XClinic/CenterNo
2261Q00000XClinic/CenterARKANSASYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1152363002MEDICAIDARKANSAS
257372MEDICARE UPINARKANSAS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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