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General NPI Number Information
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NPI Number | 1710225545
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Entity Type | Organization
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Legal Business Name | BAPTIST HEALTH FAMILY CLINIC PROTHO
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Dates
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Enumeration Date | 01/29/2013
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Last Update Date | 01/29/2013
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Provider Practice Location Address
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Address Line | 5207 E BROADWAY ST
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City | NORTH LITTLE ROCK
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State | AR
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Zip | 72117-4029
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Country | US
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Telephone | 501-945-2033
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Fax | 501-945-2303
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Provider Business Mailing Address
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Address Line | 11001 EXECUTIVE CENTER DR SUITE 200
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City | LITTLE ROCK
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State | AR
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Zip | 72211-4316
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Country | US
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Telephone | 501-812-7512
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Fax | 501-812-7507
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Authorized Official
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Title or Position | CEO
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Name | MR. WILL RUSHER
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Credential |
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Telephone | 501-812-7512
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | R2917
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License Number State | AR
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