Provider Demographics
NPI:1548239247
Name:ARKANSAS HEALTH GROUP
Entity Type:Organization
Organization Name:ARKANSAS HEALTH GROUP
Other - Org Name:PAULK FAMILY CLINIC/A BAPTIST HEALTH AFFILIATE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CLYDE
Authorized Official - Middle Name:D
Authorized Official - Last Name:PAULK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-942-5155
Mailing Address - Street 1:11001 EXECUTIVE CENTER DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-4316
Mailing Address - Country:US
Mailing Address - Phone:501-812-7800
Mailing Address - Fax:501-812-7851
Practice Address - Street 1:1110 W VINE ST
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:AR
Practice Address - Zip Code:72150-7804
Practice Address - Country:US
Practice Address - Phone:870-942-5155
Practice Address - Fax:870-942-8791
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ARKANSAS HEALTH GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-15
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC3204207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5901655OtherAETNA
AR128401002Medicaid
AR14003000000OtherQUALCHOICE
AR770017602OtherBREASTCARE
AR128401002Medicaid
AR14003000000OtherQUALCHOICE
AR0904380013Medicare NSC