Provider Demographics
NPI:1235192980
Name:ARKANSAS HEALTH GROUP
Entity Type:Organization
Organization Name:ARKANSAS HEALTH GROUP
Other - Org Name:ALL FOR KIDS PEDIATRIC CLINIC/A BAPTIST HEALTH AFFILIATE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-224-5437
Mailing Address - Street 1:904 AUTUMN RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-3737
Mailing Address - Country:US
Mailing Address - Phone:501-224-5437
Mailing Address - Fax:501-224-3473
Practice Address - Street 1:904 AUTUMN RD
Practice Address - Street 2:SUITE 100
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-3737
Practice Address - Country:US
Practice Address - Phone:501-224-5437
Practice Address - Fax:501-224-3473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-11
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5941546OtherAETNA
AR129463002Medicaid
AR=========96OtherQUALCHOICE
AR129463002Medicaid