Provider Demographics
NPI:1639978950
Name:ERAGON PRECISION HEALTH LLC
Entity type:Organization
Organization Name:ERAGON PRECISION HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:ROSIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:RICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-786-1759
Mailing Address - Street 1:400 W CAPITOL AVENUE
Mailing Address - Street 2:STE 1700 PNB 2587
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72201-3438
Mailing Address - Country:US
Mailing Address - Phone:479-448-5929
Mailing Address - Fax:
Practice Address - Street 1:2501 SHEFFIELD DRIVE
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603
Practice Address - Country:US
Practice Address - Phone:479-448-5929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-10
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1932872975Medicaid
AR1477549756Medicaid