Provider Demographics
NPI:1205977196
Name:ARKANSAS CENTER FOR WOMEN, LTD
Entity type:Organization
Organization Name:ARKANSAS CENTER FOR WOMEN, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:SHRUM
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:870-534-4900
Mailing Address - Street 1:1609 W 40TH AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-6319
Mailing Address - Country:US
Mailing Address - Phone:840-534-4900
Mailing Address - Fax:870-534-8341
Practice Address - Street 1:1609 W 40TH AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-6319
Practice Address - Country:US
Practice Address - Phone:840-534-4900
Practice Address - Fax:870-534-8341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE0704207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARG22323Medicare UPIN
AR5L175Medicare ID - Type Unspecified