Provider Demographics
NPI:1558316406
Name:CHRIST HEALTH PRIMARY CARE CLINIC
Entity Type:Organization
Organization Name:CHRIST HEALTH PRIMARY CARE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NKECHI
Authorized Official - Middle Name:PATRICIA
Authorized Official - Last Name:UGWUH-MOSS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-664-6400
Mailing Address - Street 1:500 S UNIVERSITY AVE
Mailing Address - Street 2:119
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-5302
Mailing Address - Country:US
Mailing Address - Phone:501-664-6400
Mailing Address - Fax:501-664-6431
Practice Address - Street 1:500 S UNIVERSITY AVE
Practice Address - Street 2:119
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5302
Practice Address - Country:US
Practice Address - Phone:501-664-6400
Practice Address - Fax:501-664-6431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE1042174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARG29188Medicare UPIN