Provider Demographics
NPI:1891808630
Name:STATE OF ARKANSAS
Entity Type:Organization
Organization Name:STATE OF ARKANSAS
Other - Org Name:ARKANSAS STATE HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HOSPITAL ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-686-9406
Mailing Address - Street 1:4313 W MARKHAM ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-4023
Mailing Address - Country:US
Mailing Address - Phone:501-686-9406
Mailing Address - Fax:501-686-9276
Practice Address - Street 1:4313 W MARKHAM ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-4023
Practice Address - Country:US
Practice Address - Phone:501-686-9406
Practice Address - Fax:501-686-9276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR88283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5G051Medicare PIN