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General NPI Number Information
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NPI Number | 1245035971
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Entity Type | Organization
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Legal Business Name | OLIVE BRANCH RECOVERY-ARKANSAS LLC
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Dates
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Enumeration Date | 02/17/2025
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Last Update Date | 02/17/2025
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Provider Practice Location Address
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Address Line | 6028 W STONEY BROOK RD STE 3
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City | ROGERS
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State | AR
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Zip | 72758-8180
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Country | US
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Telephone | 940-220-8899
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Fax |
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Provider Business Mailing Address
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Address Line | 6028 W STONEY BROOK RD STE 3
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City | ROGERS
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State | AR
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Zip | 72758-8180
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JACOB MUMM
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Credential |
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Telephone | 940-220-8899
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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