=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427155316
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MENA CENTER FOR WOMENS HEALTH, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2006
-----------------------------------------------------
Last Update Date | 09/02/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 400 CRESTWOOD CIR STE P
-----------------------------------------------------
City | MENA
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71953-5512
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-394-2534
-----------------------------------------------------
Fax | 479-394-7012
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 400 CRESTWOOD CIR STE P
-----------------------------------------------------
City | MENA
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71953-5512
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-394-2534
-----------------------------------------------------
Fax | 479-394-7012
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PHYSICIAN
-----------------------------------------------------
Name | DR. CARLOS BARRETT ROCHA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 479-394-2534
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | E2878
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------