Healthcare Provider Details

I. General information

NPI: 1063258218
Provider Name (Legal Business Name): ARKANSAS UROGYNECOLOGY AND WOMENS HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2024
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 SAINT VINCENT CIR STE 300
LITTLE ROCK AR
72205-5417
US

IV. Provider business mailing address

5 SAINT VINCENT CIR STE 300
LITTLE ROCK AR
72205-5417
US

V. Phone/Fax

Practice location:
  • Phone: 501-480-8800
  • Fax: 501-480-8815
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2088F0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Urology) Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: SALLIE OLIPHANT
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 412-480-9664