Healthcare Provider Details

I. General information

NPI: 1255875746
Provider Name (Legal Business Name): ARKANSAS CHILDRENS NORTHWEST, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2016
Last Update Date: 10/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 SOUTH 56TH STREET
SPRINGDALE AR
72762
US

IV. Provider business mailing address

1 CHILDRENS WAY
LITTLE ROCK AR
72202-3500
US

V. Phone/Fax

Practice location:
  • Phone: 501-364-1079
  • 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 Code282NC2000X
TaxonomyChildren's Hospital
License Number
License Number State

VIII. Authorized Official

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