Healthcare Provider Details

I. General information

NPI: 1811778509
Provider Name (Legal Business Name): ARKANSAS HYPERBARICS PLUS PERFORMANCE AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2023
Last Update Date: 10/10/2023
Certification Date: 10/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 EXECUTIVE CT STE 100
LITTLE ROCK AR
72205-4531
US

IV. Provider business mailing address

204 EXECUTIVE CT STE 100
LITTLE ROCK AR
72205-4531
US

V. Phone/Fax

Practice location:
  • Phone: 501-214-0202
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: RHONDA BLUE
Title or Position: OWNER
Credential:
Phone: 501-214-0202