| Baptist Health Family Clinic-west | |
|
6015 Chenonceau Blvd Suite 140 Little Rock AR 72223-4583 | |
| (501) 868-8410 | |
| (501) 868-8488 |
| Full Name | Baptist Health Family Clinic-west |
|---|---|
| Speciality | Family Medicine |
| Location | 6015 Chenonceau Blvd, Little Rock, Arkansas |
| Authorized Official Name and Position | Will L Rusher (CEO) |
| Authorized Official Contact | 5018127500 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Baptist Health Family Clinic-west 11001 Executive Center Dr Ste 200 Little Rock AR 72211-4393 Ph: (501) 812-7215 | Baptist Health Family Clinic-west 6015 Chenonceau Blvd Suite 140 Little Rock AR 72223-4583 Ph: (501) 868-8410 |
| NPI Number | 1528323607 |
|---|---|
| Provider Enumeration Date | 07/05/2012 |
| Last Update Date | 04/11/2019 |
| Medicare PECOS PAC ID | 7911802079 |
|---|---|
| Medicare Enrollment ID | O20120803000152 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528323607 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | E-5669 (Arkansas) | Primary |
| Provider Name | Edward J Vanderburg |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1376568204 PECOS PAC ID: 6406853753 Enrollment ID: I20061028000042 |
| Provider Name | Russell L Cranford |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1811968092 PECOS PAC ID: 6204837313 Enrollment ID: I20100429000468 |
| Provider Name | Elizabeth W Irby |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1366658346 PECOS PAC ID: 4284735069 Enrollment ID: I20110121000946 |
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