Provider Demographics
NPI:1912543240
Name:UNIVERSITY OF CENTRAL ARKANSAS
Entity Type:Organization
Organization Name:UNIVERSITY OF CENTRAL ARKANSAS
Other - Org Name:UCA STUDENT HEALTH CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:ASSOCIATE DEAN
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:LAIRAMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-450-3136
Mailing Address - Street 1:201 DONAGHEY AVE UCA STUDENT HEALTH CENTER
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72035-5001
Mailing Address - Country:US
Mailing Address - Phone:501-450-3136
Mailing Address - Fax:501-450-3370
Practice Address - Street 1:201 DONAGHEY AVE
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72035-5001
Practice Address - Country:US
Practice Address - Phone:501-450-3136
Practice Address - Fax:501-450-3370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty