Healthcare Provider Details

I. General information

NPI: 1306833678
Provider Name (Legal Business Name): BREAST HEALTH CLINICS OF ARKANSAS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 SPRINGHILL DR STE 470
NORTH LITTLE ROCK AR
72117-2924
US

IV. Provider business mailing address

PO BOX 7386
LITTLE ROCK AR
72217-7386
US

V. Phone/Fax

Practice location:
  • Phone: 501-955-9466
  • Fax: 501-955-0339
Mailing address:
  • Phone: 501-993-8324
  • Fax: 501-955-0339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JERRI S FANT
Title or Position: OWNER
Credential: MD
Phone: 501-955-9466