Basic Information
| Provider Information | |||||||||
| NPI: | 1578876959 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HALSTED | ||||||||
| FirstName: | ROSS | ||||||||
| MiddleName: | EDDINGTON | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 724 N SPRING ST STE A | ||||||||
| Address2: | |||||||||
| City: | HARRISON | ||||||||
| State: | AR | ||||||||
| PostalCode: | 726012913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8703650850 | ||||||||
| FaxNumber: | 7083650862 | ||||||||
| Practice Location | |||||||||
| Address1: | 724 N SPRING ST STE A | ||||||||
| Address2: | |||||||||
| City: | HARRISON | ||||||||
| State: | AR | ||||||||
| PostalCode: | 726012913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8703650850 | ||||||||
| FaxNumber: | 8703650862 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2010 | ||||||||
| LastUpdateDate: | 01/25/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | E7193 | AR | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207Q00000X | E7193 | AR | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 5UU32 | 01 | AR | ARKANSAS BLUE CROSS BLUE SHIELD | OTHER | 198759001 | 05 | AR | MEDICAID |