Healthcare Provider Details

I. General information

NPI: 1467423384
Provider Name (Legal Business Name): SOUTH ARKANSAS REGIONAL HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 04/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 N COLLEGE AVE
EL DORADO AR
71730-4403
US

IV. Provider business mailing address

715 N COLLEGE AVE
EL DORADO AR
71730-4403
US

V. Phone/Fax

Practice location:
  • Phone: 870-862-7921
  • Fax: 870-864-2490
Mailing address:
  • Phone: 870-862-7921
  • Fax: 870-864-2490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM C PEEL
Title or Position: EXECUTIVE DIRECTOR
Credential: PHD
Phone: 870-862-7921