| Baptist Health Family Support Program | |
|
11401 Interstate 30 Little Rock AR 72209-7042 | |
| (501) 202-6470 | |
| (501) 202-6475 |
| Full Name | Baptist Health Family Support Program |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 11401 Interstate 30, Little Rock, Arkansas |
| Authorized Official Name and Position | Troy Wells (PRESIDENT) |
| Authorized Official Contact | 5012022080 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Baptist Health Family Support Program 9601 Baptist Health Drive Little Rock AR 72205 Ph: (501) 202-2080 | Baptist Health Family Support Program 11401 Interstate 30 Little Rock AR 72209-7042 Ph: (501) 202-6470 |
| NPI Number | 1992046692 |
|---|---|
| Provider Enumeration Date | 03/06/2013 |
| Last Update Date | 10/15/2015 |
| Medicare PECOS PAC ID | 0648177949 |
|---|---|
| Medicare Enrollment ID | O20141003000135 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992046692 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Bradley C Diner |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1194793398 PECOS PAC ID: 6901887488 Enrollment ID: I20101217000218 |
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