Healthcare Provider Details

I. General information

NPI: 1548387103
Provider Name (Legal Business Name): ARKANSAS DEPARTMENT OF HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 03/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 W 10TH ST SUITE 401
LITTLE ROCK AR
72204-1752
US

IV. Provider business mailing address

4815 W MARKHAM ST SLOT 40
LITTLE ROCK AR
72205-3866
US

V. Phone/Fax

Practice location:
  • Phone: 501-280-4951
  • Fax: 501-280-4999
Mailing address:
  • Phone: 501-661-2859
  • Fax: 501-661-2691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: TERRI S WRIGHT
Title or Position: FISCAL SUPPORT SUPERVISOR
Credential: BBA
Phone: 501-661-2859