Basic Information
| Provider Information | |||||||||
| NPI: | 1588173231 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PREMISE HEALTH OF ARKANSAS MEDICAL P A | ||||||||
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| OtherOrganizationName: | THE WELLNESS CENTER OPERATED BY PREMISE HEALTH | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5500 MARYLAND WAY STE 400 | ||||||||
| Address2: | |||||||||
| City: | BRENTWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370277048 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8444077557 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | HIGHWAY 205 | ||||||||
| Address2: | HIGHLAND INDUSTRIAL PARK | ||||||||
| City: | CAMDEN | ||||||||
| State: | AR | ||||||||
| PostalCode: | 717019998 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8705745700 | ||||||||
| FaxNumber: | 8705744075 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2017 | ||||||||
| LastUpdateDate: | 09/26/2017 | ||||||||
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| AuthorizedOfficialLastName: | WOMACK | ||||||||
| AuthorizedOfficialFirstName: | CATHERINE | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6154686248 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.