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NPI Code Detail

MEDICARE: SOUTH ARKANSAS REGIONAL HEALTH CENTER

MEDICARE: SOUTH ARKANSAS REGIONAL HEALTH CENTER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1467423384
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTH ARKANSAS REGIONAL HEALTH CENTER
Provider Business Mailing Address
First Line : 715 N COLLEGE AVE
Second Line :
City : EL DORADO
State : AR
Zip : 71730-4403
Country : US
Telephone Number : 870-862-7921
Fax Number : 870-864-2490
Provider Business Practice Location Address
First Line : 715 N COLLEGE AVE
Second Line :
City : EL DORADO
State : AR
Zip : 71730-4403
Country : US
Telephone Number : 870-862-7921
Fax Number : 870-864-2490
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : WILLIAM C PEEL
Credential : PHD
Telephone Number : 870-862-7921
Provider Enumeration Date : 01/30/2006
Last Update Date : 04/28/2009

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Practice Location Address:
715 N COLLEGE AVE
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Practice Fax:
1750373395 — MR. RICHARD WORTH PECKHAM M.D.
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1356313670 — RODNEY P GOODWIN PHD
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715 N COLLEGE AVE
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1124096599 — CAROL A GARRETT PHD
Practice Location Address:
715 N COLLEGE AVE
EL DORADO, AR
71730-4403
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1821066374 — MICHAEL O DODD MS
Practice Location Address:
715 N COLLEGE AVE
EL DORADO, AR
71730-4403
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1205805116 — PHILIP C PACKARD ACSW
Practice Location Address:
715 N COLLEGE AVE
EL DORADO, AR
71730-4403
Practice Phone: 870-862-7921
Practice Fax: 870-864-2490

Directions to “SOUTH ARKANSAS REGIONAL HEALTH CENTER ” Practice Location

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