Provider Demographics
NPI:1306833678
Name:BREAST HEALTH CLINICS OF ARKANSAS PA
Entity Type:Organization
Organization Name:BREAST HEALTH CLINICS OF ARKANSAS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JERRI
Authorized Official - Middle Name:S
Authorized Official - Last Name:FANT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-955-9466
Mailing Address - Street 1:PO BOX 7386
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72217-7386
Mailing Address - Country:US
Mailing Address - Phone:501-993-8324
Mailing Address - Fax:501-955-0339
Practice Address - Street 1:3401 SPRINGHILL DR
Practice Address - Street 2:STE 470
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72117-2924
Practice Address - Country:US
Practice Address - Phone:501-955-9466
Practice Address - Fax:501-955-0339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5F331Medicare ID - Type Unspecified