Healthcare Provider Details

I. General information

NPI: 1952074916
Provider Name (Legal Business Name): UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2021
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 TOWNE CENTRE DR STE 2
MAUMELLE AR
72113-7756
US

IV. Provider business mailing address

PO BOX 251420
LITTLE ROCK AR
72225-1420
US

V. Phone/Fax

Practice location:
  • Phone: 501-686-8000
  • Fax: 501-526-5148
Mailing address:
  • Phone: 501-686-8000
  • Fax: 501-526-5148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AMANDA D GEORGE
Title or Position: VICE CHANCELLOR-CHIEF FINANCIAL OFF
Credential:
Phone: 501-686-5670