Provider Demographics
NPI:1841557725
Name:UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES
Entity Type:Organization
Organization Name:UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES
Other - Org Name:UAMS FAMILY MEDICAL CLINIC-MAGNOLIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE CHANCELLOR FOR FINANCE AND CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:MELONY
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODHAND
Authorized Official - Suffix:
Authorized Official - Credentials:JD,CPS, MS
Authorized Official - Phone:501-686-5671
Mailing Address - Street 1:4301 WEST MARKHAM STREET., SLOT# 599
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-7199
Mailing Address - Country:US
Mailing Address - Phone:501-686-5264
Mailing Address - Fax:501-686-8506
Practice Address - Street 1:104 E COLUMBIA
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:AR
Practice Address - Zip Code:71753-2436
Practice Address - Country:US
Practice Address - Phone:870-862-2489
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-18
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center