Basic Information
| Provider Information | |||||||||
| NPI: | 1902833924 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SIMMONS | ||||||||
| FirstName: | HENRY | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2909 MILITARY RD | ||||||||
| Address2: | |||||||||
| City: | BENTON | ||||||||
| State: | AR | ||||||||
| PostalCode: | 720152721 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5013156500 | ||||||||
| FaxNumber: | 5013150006 | ||||||||
| Practice Location | |||||||||
| Address1: | 2909 MILITARY RD | ||||||||
| Address2: | |||||||||
| City: | BENTON | ||||||||
| State: | AR | ||||||||
| PostalCode: | 720152721 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5013156500 | ||||||||
| FaxNumber: | 5013150006 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 146D00000X | C5728 | AR | Y | Emergency Medical Service Providers | Personal Emergency Response Attendant |
ID Information
| ID | Type | State | Issuer | Description | 54856 | 01 | AR | BCBS | OTHER |