MEDICARE: BREAST HEALTH CLINICS OF ARKANSAS PA

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	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1306833678
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BREAST HEALTH CLINICS OF ARKANSAS PA

Provider Business Mailing Address
First Line	:	PO BOX 7386
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72217-7386
Country	:	US
Telephone Number	:	501-993-8324
Fax Number	:	501-955-0339

Provider Business Practice Location Address
First Line	:	3401 SPRINGHILL DR
Second Line	:	STE 470
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72117-2924
Country	:	US
Telephone Number	:	501-955-9466
Fax Number	:	501-955-0339

Authorized Official
Title or Position	:	OWNER
Name	:	JERRI S FANT
Credential	:	MD
Telephone Number	:	501-955-9466

Provider Enumeration Date	:	10/03/2005
Last Update Date	:	08/22/2020

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