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	261QM0855X	Adolescent and Children Mental Health Clinic/Center

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	:	1457598393
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	:	621 E NORTH ST
Second Line	:
City	:	MAGNOLIA
State	:	AR
Zip	:	71753-3120
Country	:	US
Telephone Number	:	870-234-0739
Fax Number	:	870-234-0706

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

Provider Enumeration Date	:	01/14/2009
Last Update Date	:	04/07/2016

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