Healthcare Provider Details

I. General information

NPI: 1578876959
Provider Name (Legal Business Name): ROSS EDDINGTON HALSTED M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2010
Last Update Date: 09/20/2023
Certification Date: 09/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 HWY 65 N SUITE 230
HARRISON AR
72601-3911
US

IV. Provider business mailing address

1401 HWY 65 N SUITE 230
HARRISON AR
72601-3911
US

V. Phone/Fax

Practice location:
  • Phone: 870-414-5400
  • Fax: 870-414-5401
Mailing address:
  • Phone: 870-414-5400
  • Fax: 870-414-5401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE7193
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberE7193
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: