Healthcare Provider Details

I. General information

NPI: 1407864986
Provider Name (Legal Business Name): ACH PHYSICIAN CONTRACTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 MARSHALL ST
LITTLE ROCK AR
72202-3510
US

IV. Provider business mailing address

PO BOX 8088 SLOT 664
LITTLE ROCK AR
72203-8088
US

V. Phone/Fax

Practice location:
  • Phone: 501-364-2526
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number811
License Number StateAR

VIII. Authorized Official

Name: CAROL HUDGENS
Title or Position: VICE PRESIDENT
Credential:
Phone: 501-364-1079