1396187597 NPI number — ARKANSAS HEALTH GROUP

Table of content: (NPI 1396187597)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396187597 NPI number — ARKANSAS HEALTH GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARKANSAS HEALTH GROUP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BAPTIST HEALTH SPECIALTY CLINIC NORTH LITTLE ROCK
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396187597
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/18/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11001 EXECUTIVE CENTER DRIVE
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
LITTLE ROCK
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72211-4393
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-812-7215
Provider Business Mailing Address Fax Number:
501-812-7207

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3201 SPRINGHILL DR STE 350
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH LITTLE ROCK
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72117-2964
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-945-0392
Provider Business Practice Location Address Fax Number:
501-945-0394
Provider Enumeration Date:
07/29/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RUSHER
Authorized Official First Name:
WILL
Authorized Official Middle Name:
L
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
501-812-7503

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RS0012X , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0600X , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM2500X , with the licence number: C5148 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5D199 . This is a "BCBS" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 270478002 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".