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General NPI Number Information
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NPI Number | 1306833678
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Entity Type | Organization
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Legal Business Name | BREAST HEALTH CLINICS OF ARKANSAS PA
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Dates
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Enumeration Date | 10/03/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3401 SPRINGHILL DR STE 470
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City | NORTH LITTLE ROCK
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State | AR
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Zip | 72117-2924
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Country | US
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Telephone | 501-955-9466
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Fax | 501-955-0339
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Provider Business Mailing Address
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Address Line | PO BOX 7386
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City | LITTLE ROCK
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State | AR
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Zip | 72217-7386
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Country | US
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Telephone | 501-993-8324
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Fax | 501-955-0339
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Authorized Official
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Title or Position | OWNER
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Name | JERRI S FANT
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Credential | MD
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Telephone | 501-955-9466
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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