Healthcare Provider Details

I. General information

NPI: 1568954147
Provider Name (Legal Business Name): ARKANSAS HEALTH GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2018
Last Update Date: 04/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9601 BAPTIST HEALTH DR STE 250
LITTLE ROCK AR
72205
US

IV. Provider business mailing address

11001 EXECUTIVE CENTER DR STE 200
LITTLE ROCK AR
72211-4393
US

V. Phone/Fax

Practice location:
  • Phone: 501-217-4910
  • Fax: 501-217-4943
Mailing address:
  • Phone: 501-812-7215
  • Fax: 501-812-7207

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 TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: WILL RUSHER
Title or Position: CEO
Credential:
Phone: 501-812-7503