Healthcare Provider Details

I. General information

NPI: 1124057088
Provider Name (Legal Business Name): CENTRAL ARKANSAS PEDIATRIC CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 SPRINGHILL RD STE 200
BENTON AR
72015-7552
US

IV. Provider business mailing address

2301 SPRINGHILL RD STE 200
BENTON AR
72015-7552
US

V. Phone/Fax

Practice location:
  • Phone: 501-847-2500
  • Fax: 501-943-3016
Mailing address:
  • Phone: 501-847-2500
  • Fax: 501-943-3016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State

VIII. Authorized Official

Name: MRS. CHERYL ARNOLD
Title or Position: CEO
Credential:
Phone: 501-847-2500