Healthcare Provider Details

I. General information

NPI: 1609814185
Provider Name (Legal Business Name): AMERIS OF ARKANSAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 MEDICAL DRIVE
BLYTHEVILLE AR
72315
US

IV. Provider business mailing address

1520 N DIVISION ST
BLYTHEVILLE AR
72315-1448
US

V. Phone/Fax

Practice location:
  • Phone: 870-762-6725
  • Fax: 870-762-8125
Mailing address:
  • Phone: 870-762-6725
  • Fax: 870-762-8125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DENIS WELLINGTON MILLER
Title or Position: DIRECTOR
Credential:
Phone: 870-762-1190