Provider Demographics
NPI:1083936207
Name:BELL, SHAMON RASHAD (MHPP)
Entity Type:Individual
Prefix:
First Name:SHAMON
Middle Name:RASHAD
Last Name:BELL
Suffix:
Gender:M
Credentials:MHPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 DONS WAY
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-6478
Mailing Address - Country:US
Mailing Address - Phone:501-620-5231
Mailing Address - Fax:501-620-5109
Practice Address - Street 1:125 DONS WAY
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-6478
Practice Address - Country:US
Practice Address - Phone:501-620-5231
Practice Address - Fax:501-620-5109
Is Sole Proprietor?:No
Enumeration Date:2010-02-16
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR116399726Medicaid