Basic Information
Provider Information
NPI: 1316215338
EntityType: 2
ReplacementNPI:  
OrganizationName: ARKANSAS HEALTH GROUP
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
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Credential:  
OtherOrganizationName: BAPTIST HEALTH SUPPORTIVE MEDICINE
OtherOrganizationType: 3
OtherLastName:  
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Mailing Information
Address1: 11001 EXECUTIVE CENTER DR STE 200
Address2:  
City: LITTLE ROCK
State: AR
PostalCode: 722114393
CountryCode: US
TelephoneNumber: 5018127215
FaxNumber: 5018127207
Practice Location
Address1: 9601 BAPTIST HEALTH DR STE 1-B
Address2:  
City: LITTLE ROCK
State: AR
PostalCode: 722056321
CountryCode: US
TelephoneNumber: 5012022093
FaxNumber: 5012026316
Other Information
ProviderEnumerationDate: 12/05/2011
LastUpdateDate: 04/11/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: RUSHER
AuthorizedOfficialFirstName: WILL
AuthorizedOfficialMiddleName: L
AuthorizedOfficialTitleorPosition: CEO
AuthorizedOfficialTelephone: 5018127500
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
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NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208100000X  Y193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation 

No ID Information.


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