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General NPI Number Information
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NPI Number | 1558316406
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Entity Type | Organization
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Legal Business Name | CHRIST HEALTH PRIMARY CARE CLINIC
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Dates
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Enumeration Date | 05/22/2006
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Last Update Date | 08/24/2007
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Provider Practice Location Address
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Address Line | 500 S UNIVERSITY AVE 119
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City | LITTLE ROCK
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State | AR
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Zip | 72205-5302
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Country | US
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Telephone | 501-664-6400
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Fax | 501-664-6431
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Provider Business Mailing Address
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Address Line | 500 S UNIVERSITY AVE 119
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City | LITTLE ROCK
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State | AR
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Zip | 72205-5302
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Country | US
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Telephone | 501-664-6400
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Fax | 501-664-6431
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Authorized Official
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Title or Position | DOCTOR/OWNER
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Name | DR. NKECHI PATRICIA UGWUH-MOSS
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Credential | MD
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Telephone | 501-664-6400
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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 | E1042
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License Number State | AR
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