Healthcare Provider Details

I. General information

NPI: 1972189694
Provider Name (Legal Business Name): ARKANSAS CHILDREN'S HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2021
Last Update Date: 03/23/2021
Certification Date: 03/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 WEST 42ND AVENUE
PINE BLUFF AR
71603-7006
US

IV. Provider business mailing address

1 CHILDRENS WAY # 664
LITTLE ROCK AR
72202-3500
US

V. Phone/Fax

Practice location:
  • Phone: 501-364-2526
  • Fax: 501-364-2438
Mailing address:
  • Phone: 501-364-2526
  • Fax: 501-364-2438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: SHERYL PHILLIPS
Title or Position: SR. BILLING/SYSTEMS MANAGER
Credential:
Phone: 501-364-2526