=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558794727
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | H2NAYUC PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/12/2013
-----------------------------------------------------
Last Update Date | 03/17/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14524 CANTRELL RD SUITE 160
-----------------------------------------------------
City | LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72223-4702
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-868-4400
-----------------------------------------------------
Fax | 501-868-8788
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14524 CANTRELL RD SUITE 160
-----------------------------------------------------
City | LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72223-4702
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-868-4400
-----------------------------------------------------
Fax | 501-868-8788
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. SAMUEL HEATH NAY
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 501-868-4400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QU0200X
-----------------------------------------------------
Taxonomy Name | Urgent Care Clinic/Center
-----------------------------------------------------
License Number | E-5477
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------