Provider Demographics
NPI:1659971505
Name:BAPTIST HEALTH
Entity Type:Organization
Organization Name:BAPTIST HEALTH
Other - Org Name:BAPTIST HEALTH SUPPORTIVE CARE AT HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TROY
Authorized Official - Middle Name:
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-202-2080
Mailing Address - Street 1:11900 COLONEL GLENN RD STE 2000
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72210-2829
Mailing Address - Country:US
Mailing Address - Phone:501-202-7474
Mailing Address - Fax:501-202-7793
Practice Address - Street 1:11900 COLONEL GLENN RD STE 2000
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72210-2829
Practice Address - Country:US
Practice Address - Phone:501-202-6043
Practice Address - Fax:501-202-7793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative MedicineGroup - Multi-Specialty
No2278P3800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedPalliative/HospiceGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR126783747Medicaid