Basic Information
| Provider Information | |||||||||
| NPI: | 1164152815 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | UNITY HEALTH - NEWPORT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1117 MCLAIN ST | ||||||||
| Address2: | |||||||||
| City: | NEWPORT | ||||||||
| State: | AR | ||||||||
| PostalCode: | 721123500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8704951260 | ||||||||
| FaxNumber: | 8704951262 | ||||||||
| Practice Location | |||||||||
| Address1: | 1117 MCLAIN ST | ||||||||
| Address2: | |||||||||
| City: | NEWPORT | ||||||||
| State: | AR | ||||||||
| PostalCode: | 721123500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8704951260 | ||||||||
| FaxNumber: | 8704951262 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2022 | ||||||||
| LastUpdateDate: | 06/15/2022 | ||||||||
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| AuthorizedOfficialLastName: | POOL | ||||||||
| AuthorizedOfficialFirstName: | CASSIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 5012788346 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | UNITY HEALTH - NEWPORT | ||||||||
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| NPICertificationDate: | 06/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.