Baptist Health Pediatric Clinic Conway | |
625 United Dr Ste 410 Conway AR 72032-7810 | |
(501) 358-6892 | |
(501) 358-6894 |
Full Name | Baptist Health Pediatric Clinic Conway |
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Speciality | Clinic/Center |
Location | 625 United Dr Ste 410, Conway, Arkansas |
Authorized Official Name and Position | Will Rusher (CEO) |
Authorized Official Contact | 5018127503 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Baptist Health Pediatric Clinic Conway 11001 Excecutive Center Drive 200 Little Rock AR 72211-4393 Ph: (501) 358-6892 | Baptist Health Pediatric Clinic Conway 625 United Dr Ste 410 Conway AR 72032-7810 Ph: (501) 358-6892 |
NPI Number | 1700311222 |
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Provider Enumeration Date | 04/21/2017 |
Last Update Date | 09/20/2023 |
Medicare PECOS PAC ID | 7911802079 |
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Medicare Enrollment ID | O20171017003695 |
Identifier | Type | State | Issuer |
---|---|---|---|
1700311222 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | (* (Not Available)) | Primary |
Provider Name | Dirk T Haselow |
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Provider Type | Practitioner - Pediatric Medicine |
Provider Identifiers | NPI Number: 1679746622 PECOS PAC ID: 0446428817 Enrollment ID: I20110801000008 |
Provider Name | Janell T Vinson |
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Provider Type | Practitioner - Pediatric Medicine |
Provider Identifiers | NPI Number: 1376758029 PECOS PAC ID: 1951598150 Enrollment ID: I20180822002682 |
Provider Name | Carly A Roark |
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Provider Type | Practitioner - Pediatric Medicine |
Provider Identifiers | NPI Number: 1316478845 PECOS PAC ID: 2860760915 Enrollment ID: I20200710000292 |
Provider Name | Ryan M Southard |
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Provider Type | Practitioner - Pediatric Medicine |
Provider Identifiers | NPI Number: 1093178915 PECOS PAC ID: 0244522365 Enrollment ID: I20220601001399 |
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