Provider Demographics
NPI:1164622213
Name:MICHELLE D. MITCHELL, MD PA
Entity Type:Organization
Organization Name:MICHELLE D. MITCHELL, MD PA
Other - Org Name:SERENITY CENTER FOR WOMEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:D
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-525-9500
Mailing Address - Street 1:1635 HIGDON FERRY RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-6913
Mailing Address - Country:US
Mailing Address - Phone:501-525-9500
Mailing Address - Fax:501-525-9504
Practice Address - Street 1:1635 HIGDON FERRY RD
Practice Address - Street 2:SUITE B
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-6913
Practice Address - Country:US
Practice Address - Phone:501-525-9500
Practice Address - Fax:501-525-9504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-18
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE4190174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H63905Medicare UPIN
5N014Medicare PIN