Healthcare Provider Details

I. General information

NPI: 1801951215
Provider Name (Legal Business Name): ARKANSAS HEALTH GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 05/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6800 LINDSEY RD
LITTLE ROCK AR
72206-3877
US

IV. Provider business mailing address

11001 EXECUTIVE CENTER DR SUITE 200
LITTLE ROCK AR
72211-4316
US

V. Phone/Fax

Practice location:
  • Phone: 501-490-1633
  • Fax: 501-490-0770
Mailing address:
  • Phone: 501-812-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberE0002
License Number StateAR

VIII. Authorized Official

Name: KIM TITSWORTH
Title or Position: PRACTICE MANAGEMENT ADMINISTRATOR
Credential:
Phone: 501-812-7512