1306833678 NPI number — BREAST HEALTH CLINICS OF ARKANSAS PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306833678 NPI number — BREAST HEALTH CLINICS OF ARKANSAS PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BREAST HEALTH CLINICS OF ARKANSAS PA
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:
Provider Other Organization Name Type Code:
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:
1306833678
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7386
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LITTLE ROCK
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72217-7386
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-993-8324
Provider Business Mailing Address Fax Number:
501-955-0339

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3401 SPRINGHILL DR
Provider Second Line Business Practice Location Address:
STE 470
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:
72117-2924
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-955-9466
Provider Business Practice Location Address Fax Number:
501-955-0339
Provider Enumeration Date:
10/03/2005

Additional Information

Authorized Official

Authorized Official Last Name:
FANT
Authorized Official First Name:
JERRI
Authorized Official Middle Name:
S
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
501-955-9466

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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