Healthcare Provider Details

I. General information

NPI: 1144623679
Provider Name (Legal Business Name): SOUTHERN ARKANSAS UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2014
Last Update Date: 10/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E UNIVERSITY
MAGNOLIA AR
71753-2181
US

IV. Provider business mailing address

100 E UNIVERSITY
MAGNOLIA AR
71753-2181
US

V. Phone/Fax

Practice location:
  • Phone: 870-235-4142
  • Fax: 870-235-4988
Mailing address:
  • Phone: 870-235-4142
  • Fax: 870-235-4988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID F RANKIN
Title or Position: UNIVERISTY PRESIDENT
Credential:
Phone: 870-235-4142