Provider Demographics
NPI: | 1346769767 |
---|---|
Name: | ARKANSAS HEALTH GROUP |
Entity Type: | Organization |
Organization Name: | ARKANSAS HEALTH GROUP |
Other - Org Name: | BAPTIST HEALTH NEUROLOGY-CONWAY |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | CEO |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | WILL |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | RUSHER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 501-812-7503 |
Mailing Address - Street 1: | 11001 EXECUTIVE CENTER DR STE 200 |
Mailing Address - Street 2: | |
Mailing Address - City: | LITTLE ROCK |
Mailing Address - State: | AR |
Mailing Address - Zip Code: | 72211-4393 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 501-812-7521 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 625 UNITED DR STE 370B |
Practice Address - Street 2: | |
Practice Address - City: | CONWAY |
Practice Address - State: | AR |
Practice Address - Zip Code: | 72032-7826 |
Practice Address - Country: | US |
Practice Address - Phone: | 501-358-6793 |
Practice Address - Fax: | 501-358-6853 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2017-09-18 |
Last Update Date: | 2019-04-11 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Single Specialty |