Healthcare Provider Details

I. General information

NPI: 1275637829
Provider Name (Legal Business Name): BAPTIST HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 01/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9601 BAPTIST HEALTH DR STE 109
LITTLE ROCK AR
72205-6323
US

IV. Provider business mailing address

9601 BAPTIST HEALTH DR STE 109
LITTLE ROCK AR
72205-6323
US

V. Phone/Fax

Practice location:
  • Phone: 501-202-1388
  • Fax: 501-202-6221
Mailing address:
  • Phone: 501-202-1388
  • Fax: 501-202-6221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License NumberAR06911
License Number StateAR

VIII. Authorized Official

Name: IAN MCQUEEN
Title or Position: DIRECTOR OF PHARMACY
Credential:
Phone: 501-202-2462