Provider Demographics
NPI:1609849710
Name:ARKANSAS HEALTH GROUP
Entity Type:Organization
Organization Name:ARKANSAS HEALTH GROUP
Other - Org Name:BAPTIST HEALTH FAMILY CLINIC- BRYANT
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:501-812-7800
Mailing Address - Fax:501-812-7777
Practice Address - Street 1:4411 HIGHWAY 5 N
Practice Address - Street 2:
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022-7005
Practice Address - Country:US
Practice Address - Phone:501-847-0289
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ARKANSAS HEALTH GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-09
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
71067816050OtherQUALCHOICE
AR128284002Medicaid
AR5B520OtherBCBS
AR5738040OtherAETNA
AR128284002Medicaid
AR080051256Medicare PIN
AR5B520OtherBCBS
0904380019Medicare NSC
ARCH1798Medicare PIN