Provider Demographics
NPI:1174285373
Name:NORTHWEST ARKANSAS HBP SERVICES LLC
Entity Type:Organization
Organization Name:NORTHWEST ARKANSAS HBP SERVICES LLC
Other - Org Name:NORTHWEST ARKANSAS HBP SERVICES LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR DR ONBOARDIGN & PROV ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-892-9815
Mailing Address - Street 1:PO BOX 689022
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37068-9022
Mailing Address - Country:US
Mailing Address - Phone:615-465-3334
Mailing Address - Fax:615-465-3002
Practice Address - Street 1:1580 E CENTERTON BLVD
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-4836
Practice Address - Country:US
Practice Address - Phone:479-553-2150
Practice Address - Fax:479-795-1851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-06
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPENDINGMedicaid