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General NPI Number Information
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NPI Number | 1568643005
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Entity Type | Organization
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Legal Business Name | SGOH ACQUISITION INC
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Dates
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Enumeration Date | 11/26/2007
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Last Update Date | 07/16/2024
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Provider Practice Location Address
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Address Line | 1101 JACKSON ST SW
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City | GRAVETTE
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State | AR
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Zip | 72736-9121
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Country | US
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Telephone | 479-787-5291
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Fax | 479-344-6404
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Provider Business Mailing Address
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Address Line | 1101 JACKSON ST SW
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City | GRAVETTE
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State | AR
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Zip | 72736-9121
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Country | US
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Telephone | 479-787-5291
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Fax | 417-832-9041
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Authorized Official
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Title or Position | ADMINISTRATOR/CEO
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Name | PAUL GREGORY TAYLOR
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Credential |
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Telephone | 417-837-2000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | AR4517
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | AR4517
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License Number State | AR
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Taxonomy #3
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QC0050X
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Taxonomy Name | Critical Access Hospital Clinic/Center
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License Number | AR4517
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License Number State | AR
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Taxonomy #5
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Taxonomy Code | 282NC0060X
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Taxonomy Name | Critical Access Hospital
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License Number |
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License Number State |
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