Healthcare Provider Details

I. General information

NPI: 1205977196
Provider Name (Legal Business Name): ARKANSAS CENTER FOR WOMEN, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1609 W 40TH AVE SUITE 203
PINE BLUFF AR
71603-6319
US

IV. Provider business mailing address

1609 W 40TH AVE SUITE 203
PINE BLUFF AR
71603-6319
US

V. Phone/Fax

Practice location:
  • Phone: 840-534-4900
  • Fax: 870-534-8341
Mailing address:
  • Phone: 840-534-4900
  • Fax: 870-534-8341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberE0704
License Number StateAR

VIII. Authorized Official

Name: KELLY DEAN SHRUM
Title or Position: PRESIDENT
Credential: D.O.
Phone: 870-534-4900