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General NPI Number Information
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NPI Number | 1427143551
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Entity Type | Organization
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Legal Business Name | ARKANSAS HEALTH GROUP
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 05/23/2008
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Provider Practice Location Address
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Address Line | 3343 SPRINGHILL DR STE 2050
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City | NORTH LITTLE ROCK
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State | AR
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Zip | 72117-2946
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Country | US
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Telephone | 501-945-0246
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Fax | 501-945-0216
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Provider Business Mailing Address
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Address Line | 3343 SPRINGHILL DR STE 2050
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City | NORTH LITTLE ROCK
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State | AR
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Zip | 72117-2946
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Country | US
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Telephone | 501-945-0246
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Fax | 501-945-0216
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Authorized Official
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Title or Position | CLINICAL SUPERVISOR
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Name | INGRID J BLAKE
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Credential |
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Telephone | 501-945-0246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | E3782
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License Number State | AR
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