Provider Demographics
NPI:1558330969
Name:ARKANSAS HEALTH GROUP
Entity Type:Organization
Organization Name:ARKANSAS HEALTH GROUP
Other - Org Name:BENTON FAMILY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILL
Authorized Official - Middle Name:L
Authorized Official - Last Name:RUSHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-812-7500
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:501-812-7215
Mailing Address - Fax:501-812-7207
Practice Address - Street 1:819 W CARPENTER ST
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015-3349
Practice Address - Country:US
Practice Address - Phone:501-778-8264
Practice Address - Fax:501-778-7360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-16
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR128269002Medicaid
AR128269002Medicaid
AR0904380002Medicare NSC
ARCI2383Medicare PIN