Healthcare Provider Details
I. General information
NPI: 1831888536
Provider Name (Legal Business Name): ARKANSAS HEALTH GROUP
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 05/08/2023
Last Update Date: 05/08/2023
Certification Date: 05/08/2023
Deactivation Date:
Reactivation Date:
III. Provider practice location address
605 SALEM RD STE B3
CONWAY AR
72034-4863
US
IV. Provider business mailing address
11001 EXECUTIVE CENTER DR STE 200
LITTLE ROCK AR
72211-4393
US
V. Phone/Fax
- Phone: 501-585-3935
- Fax: 501-585-2955
- Phone: 501-812-7215
- Fax: 501-812-7207
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207Q00000X |
| Taxonomy | Family Medicine Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
WILL
RUSHER
Title or Position: CEO
Credential:
Phone: 501-812-7503