MEDICARE: PHILANDER SMITH UNIVERSITY

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	261QS1000X	Student Health Clinic/Center

General Provider Information

NPI Number	:	1225870306
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHILANDER SMITH UNIVERSITY

Provider Business Mailing Address
First Line	:	900 W DAISY L GATSON BATES DR
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72202-3726
Country	:	US
Telephone Number	:	501-370-5333
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 W DAISY L GATSON BATES DR
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72202-3726
Country	:	US
Telephone Number	:	501-370-5333
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	DEVETA CROUTHER
Credential	:	RN
Telephone Number	:	501-370-5333

Provider Enumeration Date	:	06/10/2024
Last Update Date	:	06/10/2024

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Directions to “PHILANDER SMITH UNIVERSITY ” Practice Location

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