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General NPI Number Information
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NPI Number | 1114058682
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Entity Type | Organization
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Legal Business Name | PROSPECTIVE HEALTH LTD
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Dates
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Enumeration Date | 03/08/2007
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Last Update Date | 09/03/2024
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Provider Practice Location Address
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Address Line | 1304 MILITARY RD
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City | BENTON
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State | AR
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Zip | 72015
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Country | US
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Telephone | 501-778-0934
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Fax | 501-778-8377
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Provider Business Mailing Address
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Address Line | 1304 MILITARY RD
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City | BENTON
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State | AR
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Zip | 72015
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Country | US
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Telephone | 501-778-0934
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Fax | 501-778-8377
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | COURTNEY E SALMON
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Credential |
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Telephone | 501-303-7779
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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