Basic Information
| Provider Information | |||||||||
| NPI: | 1518341643 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ARKANSAS OCCUPATIONAL HEALTH CLINIC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4001 WAGON WHEEL RD | ||||||||
| Address2: | |||||||||
| City: | SPRINGDALE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727620137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4797253001 | ||||||||
| FaxNumber: | 4797253098 | ||||||||
| Practice Location | |||||||||
| Address1: | 4001 WAGON WHEEL RD | ||||||||
| Address2: | |||||||||
| City: | SPRINGDALE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727620137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4797253001 | ||||||||
| FaxNumber: | 4797253098 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2015 | ||||||||
| LastUpdateDate: | 07/18/2015 | ||||||||
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| AuthorizedOfficialLastName: | MOFFITT | ||||||||
| AuthorizedOfficialFirstName: | LUKE | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 4797253055 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LX0106X | ATP-000823 | AR | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Occupational Health |
No ID Information.