Healthcare Provider Details

I. General information

NPI: 1477569218
Provider Name (Legal Business Name): ARKANSAS EPILEPSY PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 05/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 LILE CT S-100
LITTLE ROCK AR
72205-6221
US

IV. Provider business mailing address

2 LILE CT STE 100
LITTLE ROCK AR
72205-6241
US

V. Phone/Fax

Practice location:
  • Phone: 501-227-5061
  • Fax: 501-227-5234
Mailing address:
  • Phone: 501-227-5061
  • Fax: 501-227-5234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberR-4085
License Number StateAR

VIII. Authorized Official

Name: BARBARA SCHWERMAN
Title or Position: SENIOR ACCOUNTS REP
Credential:
Phone: 501-227-0705