Healthcare Provider Details

I. General information

NPI: 1093018723
Provider Name (Legal Business Name): REVIVE HEARING CENTER OF ARKANSAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2010
Last Update Date: 12/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10700 N RODNEY PARHAM RD STE A7
LITTLE ROCK AR
72212-4159
US

IV. Provider business mailing address

10700 N RODNEY PARHAM RD STE A7
LITTLE ROCK AR
72212-4159
US

V. Phone/Fax

Practice location:
  • Phone: 501-225-6060
  • Fax: 501-225-6450
Mailing address:
  • Phone: 501-225-6060
  • Fax: 501-225-6450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number331
License Number StateAR

VIII. Authorized Official

Name: MRS. ANN DAY
Title or Position: CONTROLLER
Credential:
Phone: 718-360-1143