Healthcare Provider Details

I. General information

NPI: 1215935234
Provider Name (Legal Business Name): UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3417 U OF A WAY
TEXARKANA AR
71854-1419
US

IV. Provider business mailing address

3417 U OF A WAY
TEXARKANA AR
71854-1419
US

V. Phone/Fax

Practice location:
  • Phone: 870-779-6000
  • Fax: 870-779-6093
Mailing address:
  • Phone: 870-779-6000
  • Fax: 870-779-6093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AMANDA D GEORGE
Title or Position: VICE CHANCELLOR-CHIEF FINANCIAL OFF
Credential:
Phone: 501-686-5670