Healthcare Provider Details

I. General information

NPI: 1578593067
Provider Name (Legal Business Name): BAPTIST HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 10/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9601 BAPTIST HEALTH DRIVE
LITTLE ROCK AR
72205
US

IV. Provider business mailing address

9601 BAPTIST HEALTH DRIVE
LITTLE ROCK AR
72205
US

V. Phone/Fax

Practice location:
  • Phone: 501-202-2080
  • Fax: 501-202-1722
Mailing address:
  • Phone: 501-202-2080
  • Fax: 501-202-1722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License NumberAR3886
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License NumberAR3886
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberAR3886
License Number StateAR

VIII. Authorized Official

Name: RUSSELL D. HARRINGTON
Title or Position: CEO/PRESIDENT
Credential:
Phone: 501-202-2274