Provider Demographics
NPI:1083978977
Name:JENNIFER BINGHAM MD PLLC
Entity Type:Organization
Organization Name:JENNIFER BINGHAM MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:BINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-351-9476
Mailing Address - Street 1:15785 W HIGHWAY 62
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE GROVE
Mailing Address - State:AR
Mailing Address - Zip Code:72753-9201
Mailing Address - Country:US
Mailing Address - Phone:479-351-9476
Mailing Address - Fax:479-287-4586
Practice Address - Street 1:15785 W HIGHWAY 62 STE 1
Practice Address - Street 2:
Practice Address - City:PRAIRIE GROVE
Practice Address - State:AR
Practice Address - Zip Code:72753-9201
Practice Address - Country:US
Practice Address - Phone:479-351-9476
Practice Address - Fax:479-287-4586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-26
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR135065001Medicaid
AR135065001Medicaid