Healthcare Provider Details

I. General information

NPI: 1326036609
Provider Name (Legal Business Name): BEN L BECK CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 08/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 BAYSHORE DR
HOT SPRINGS AR
71901-9244
US

IV. Provider business mailing address

420 BAYSHORE DR
HOT SPRINGS AR
71901-9244
US

V. Phone/Fax

Practice location:
  • Phone: 501-282-3824
  • Fax: 501-262-5000
Mailing address:
  • Phone: 501-282-3824
  • Fax: 501-262-5000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberC00905
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: