Provider Demographics
NPI:1629108949
Name:CHRIS TAYLOR COSMETICS
Entity Type:Organization
Organization Name:CHRIS TAYLOR COSMETICS
Other - Org Name:BLADDER AND BOWEL INSTITUTION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RONNIE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MCALISTER
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:870-741-1616
Mailing Address - Street 1:1425 ROCK SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72601-8933
Mailing Address - Country:US
Mailing Address - Phone:870-741-1616
Mailing Address - Fax:870-741-2211
Practice Address - Street 1:1425 ROCK SPRINGS RD
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-8933
Practice Address - Country:US
Practice Address - Phone:870-741-1616
Practice Address - Fax:870-741-2211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207V00000X
ARE-2602261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR200787128Medicaid
AR140523001Medicaid