Healthcare Provider Details
I. General information
NPI: 1346610946
Provider Name (Legal Business Name): ARKANSAS HEALTH GROUP
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 09/25/2015
Last Update Date: 04/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
9601 BAPTIST HEALTH DR STE 750
LITTLE ROCK AR
72205-6370
US
IV. Provider business mailing address
11001 EXECUTIVE CENTER DR STE 200
LITTLE ROCK AR
72211-4393
US
V. Phone/Fax
- Phone: 501-224-0200
- Fax: 501-224-2292
- Phone: 501-812-7215
- Fax: 501-812-7207
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2084N0400X |
| Taxonomy | Neurology Physician |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207T00000X |
| Taxonomy | Neurological Surgery Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: MR.
WILL
RUSHER
Title or Position: CEO
Credential:
Phone: 501-812-7500