Provider Demographics
NPI:1720734247
Name:SELAH HEALTH
Entity Type:Organization
Organization Name:SELAH HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:GAIL
Authorized Official - Last Name:SMALLMON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:870-970-3180
Mailing Address - Street 1:PO BOX 301
Mailing Address - Street 2:
Mailing Address - City:PIGGOTT
Mailing Address - State:AR
Mailing Address - Zip Code:72454-0301
Mailing Address - Country:US
Mailing Address - Phone:870-970-3180
Mailing Address - Fax:870-201-9686
Practice Address - Street 1:180 S THORNTON AVE
Practice Address - Street 2:
Practice Address - City:PIGGOTT
Practice Address - State:AR
Practice Address - Zip Code:72454-2731
Practice Address - Country:US
Practice Address - Phone:870-970-3180
Practice Address - Fax:870-343-6262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-23
Last Update Date:2024-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1447481072OtherAMANDA SMALLMON'S NPI #
1518246438OtherTAMMY TRIPP, LSCW, NPI#
AR291504758Medicaid