Provider Demographics
NPI:1164519450
Name:LIFESPRING WOMEN'S HEALTHCARE PA
Entity Type:Organization
Organization Name:LIFESPRING WOMEN'S HEALTHCARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:J
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:HANNAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-271-0005
Mailing Address - Street 1:1200 SE 28TH ST
Mailing Address - Street 2:2
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-3881
Mailing Address - Country:US
Mailing Address - Phone:479-271-0005
Mailing Address - Fax:473-273-1427
Practice Address - Street 1:1200 SE 28TH ST
Practice Address - Street 2:2
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-3881
Practice Address - Country:US
Practice Address - Phone:479-271-0005
Practice Address - Fax:479-273-1427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR162837002Medicaid
AR5F652OtherBCBS
AR5F652Medicare PIN