Provider Demographics
NPI:1366632887
Name:HEALTH MANAGEMENT OF ARKANSAS
Entity Type:Organization
Organization Name:HEALTH MANAGEMENT OF ARKANSAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:FREDERICK
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:501-374-1153
Mailing Address - Street 1:636 W BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72114-5526
Mailing Address - Country:US
Mailing Address - Phone:501-374-1153
Mailing Address - Fax:501-374-6213
Practice Address - Street 1:636 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72114-5526
Practice Address - Country:US
Practice Address - Phone:501-374-1153
Practice Address - Fax:501-374-6213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-31
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARQ41710Medicare UPIN
AR5965430001Medicare NSC
ART20518Medicare UPIN
LAB63905Medicare UPIN
ARC68672Medicare UPIN