Healthcare Provider Details

I. General information

NPI: 1962161901
Provider Name (Legal Business Name): ARKANSAS CHILDRENS NORTHWEST, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2021
Last Update Date: 12/16/2021
Certification Date: 12/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 GENE GEORGE BLVD
SPRINGDALE AR
72762-0845
US

IV. Provider business mailing address

PO BOX 959794
SAINT LOUIS MO
63195-9794
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 Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number State

VIII. Authorized Official

Name: SHERYL PHILLIPS
Title or Position: A/R CONTROL MANAGER
Credential:
Phone: 501-364-2526