MEDICARE: UNITED METHODIST BEHAVIORAL HEALTH SYSTEM, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	283Q00000X	Psychiatric Hospital	AR4089	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	14017	OTHER	AR	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1063415800
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNITED METHODIST BEHAVIORAL HEALTH SYSTEM, INC

Provider Business Mailing Address
First Line	:	1600 ALDERSGATE RD
Second Line	:	SUITE 200
City	:	LITTLE ROCK
State	:	AR
Zip	:	72205-6676
Country	:	US
Telephone Number	:	501-661-0720
Fax Number	:	501-325-7938

Provider Business Practice Location Address
First Line	:	1601 MURPHY DRIVE
Second Line	:
City	:	MAUMELLE
State	:	AR
Zip	:	72113
Country	:	US
Telephone Number	:	501-803-3388
Fax Number	:	501-803-4272

Authorized Official
Title or Position	:	CFO
Name	:	MR. LESLEY DON COLE
Credential	:
Telephone Number	:	501-661-0720

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	04/07/2016

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