MEDICARE: ARKANSAS HEALTH GROUP

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	2086S0129X	Vascular Surgery Physician

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

General Provider Information

NPI Number	:	1346317476
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARKANSAS HEALTH GROUP

Provider Business Mailing Address
First Line	:	11001 EXECUTIVE CENTER DR
Second Line	:	SUITE 200
City	:	LITTLE ROCK
State	:	AR
Zip	:	72211-4316
Country	:	US
Telephone Number	:	501-812-7587
Fax Number	:

Provider Business Practice Location Address
First Line	:	9601 LILE DR STE 250
Second Line	:	MEDICAL TOWERS 1
City	:	LITTLE ROCK
State	:	AR
Zip	:	72205-6355
Country	:	US
Telephone Number	:	501-227-4787
Fax Number	:

Authorized Official
Title or Position	:	PMA
Name	:	TOMMY JOHNSON
Credential	:
Telephone Number	:	501-812-7514

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	05/22/2008

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Directions to “ARKANSAS HEALTH GROUP ” Practice Location

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